MP-16.07: Comparative Analysis between Robotic Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy: Defining the Initial Learning Curve

MODERATED POSTER SESSIONS

MP-16.06 Is Body Mass Index (BMI) Related to Pre-Therapy Testosterone and the Prognosis of Prostate Adenocarcinoma? Xu C, Zhang Z, Hou J, Gao X, Gao X, Wang L, Sun Y Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, China Introduction and Objective: Body mass index (BMI), calculated as weight in kg divided by the square of height in m, is used as an indicator of obesity. Testosterone is one of the most important hormones, which is also related to obesity. This study analyzed the relationship of BMI with the prognositic factors of prostate adenocarcinoma, the relationship of BMI and pre-therapy testosterone is also assessed. Materials and Methods: A total of 256 cases of prostate adenocarcinoma were retrospectively studied. Age, height, weight, pre-therapy prostate specific antigen, pre-therapy testosterone, size of prostate, percentage of positive biopsies (PPBs) at diagnosis of prostate adenocarcinoma were analyzed, results of radical prostatectomy such as positive edge. Gleason score of surgical specimen and lymph node metastasis were also analyzed. Classified all the cases into different categories according to the pathological features and clinical classification respectively, then compared the difference of BMI among the categories and analyzed the relationship of BMI with the prognositic factors of prostate adenocarcinoma. Results: 1.The BMI of this study was higher than normal (24.10⫾2.81), and the pre-therapy testosterone differed significantly from each. 2. When adjusted by age, there was no significant difference in BMI among 4 clinical stages (ANOVA, P⬎0.05), but significant among 4 pathological categories (ANCOVA, P⬍0.01), especially the category of Gleason 8-10 was higher than the other categories (each P⬍0.01). Between BMIⱖ24 group and BMI⬍24 group, there was significant difference in PPBs (Wilcoxon test, P⬍0.05) and rate of positive edge (Chisquare, P⬍0.05). 3. BMI was negatively related to pre-therapy testosterone with significant difference, the correlation coefficient was -0.252 (P⬍0.01).

Chen P1, Rasiah K1, Thanigasalam R1, Henshall S1, Stricker P2 1 The Garvan Institute of Medical Research, Darlinghurst, Australia; 2St Vincent’s Clinic, Darlinghurst, Australia Introduction and Objective: Robotic Assisted Laparoscopic Prostatectomy (RALP) is becoming an increasingly popular minimally invasive treatment for patients with localised prostate cancer. We present an early experience of the clinicopathological outcomes in patients undergoing RALP and open radical prostatectomy (ORP). We also aim to identify issues an experienced urologist may face when transferring skills from ORP to RALP. Materials and Methods: Between 2006 and 2008 in a single surgeon series, 712 consecutive patients with clinically localised prostate cancer were treated with radical prostatectomy, RALP in 222 and ORP in 490. Prospectively collected clinical and pathological data were analysed. Results: Preoperative characteristics were similar between the 2 groups, mean age 60.6 years, PSA 8.1 ng/ml, prostate weight 52.7 grams and tumour volume 1.9cm3 in the entire cohort. There were no conversions to open surgery, no bowel injuries, no blood transfusions and no deaths in the RALP cohort. 98% of RALP patients had ⬍500mls of blood loss compared with 63% (p⬍0.001) of open radical prostatectomy (ORP) patients. In the ORP group 2% of patients required transfusion. Median hospital stay was 3 days vs. 6 days, and mean operating time was 200 vs. 144 minutes for RALP and ORP patients respectively. The RALP learning curve to a 4 hour proficiency was 20 patients. Overall positive surgical margin status for pathological stage T2 were comparable in the 2 groups: 9% vs. 8%, RALP vs. ORP, p⫽0.9 but significantly different in pT3 patients: 40% vs. 26%, RALP vs. ORP, p⫽0.02. There was a significant decrease in overall positive surgical margin status from 40% in the first 20 consecutive patients treated with RALP to 14.6% for patients treated thereafter (p⫽0.005). This indicates a short learning curve in

MP-16.07 Comparative Analysis between Robotic Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy: Defining the Initial Learning Curve

UROLOGY 74 (Supplment 4A), October 2009

achieving adequate tumour resection in robotic prostatectomy. Conclusions: Robotic assisted laparoscopic prostatectomy provided comparable pathological outcomes compared with open radical prostatectomy after the initial short learning curve. Favourable shortterm operative outcomes for RALP include less blood loss, a lower transfusion requirement, shorter hospital stay and less major complications. MP-16.08 Outcome of Radical Retropubic Prostatectomy in Patients with Total Prostate-Specific Antigen Value Less Than 2.5 Ng/Ml Pushkar D1, Govorov A1, Diakov V1, Kosko J2 1 Department of Urology of MSMSU, Moscow, Russia; 2Urology, MeritCare Bemidji, Bemidji, USA Introduction and Objective: The detection of prostate cancer (PCa) in patients with total PSA value less than 2.5 ng/ml is a relatively rare event in a routine practice. The aim of our study was to assess the outcome of radical retropubic prostatectomy (RP) in men with PSA ⬍2.5 ng/ml and to evaluate clinical and postoperative pathological features of these patients. Material and Methods: We retrospectively analyzed the results of RP in 58 men with a preoperative PSA level ⬍2.5 ng/ml operated between 2001 and 2007. Indications for prostate biopsy in these patients were abnormal digital rectal examination (DRE) (n⫽26; 44.8%), abnormal transrectal ultrasound (n⫽3; 5.2%), hematospermia (n⫽4; 6.9%), increased PSA velocity (n⫽5; 8.6%) etc. In 8.6% of patients (n⫽5) the PCa was diagnosed after transurethral resection (TUR) of the prostate. The mean total PSA value was 1.6 (0.42.4) ng/ml. Results: The rate of detection of Gleason score (GS) of 7 or more in biopsy and RP specimen, as well as mean RP tumour volume were significantly higher in patients with abnormal DRE comparing to those with normal DRE (see table). There was a

MP-16.08, Table. Characteristics of Tumours Depending on DRE Findings Biopsy GS ⱖ7 RP GS ⱖ7 Mean tumour volume Stage pT2 Positive surgical margins Seminal vesicles invasion Lymph nodes invasion

Normal DRE 17.6% 35.3% 1.22 cc 76.5% 11.8% 17.6% 5.8%

Abnormal DRE 34.1% 51.2% 2.64 cc 61% 14.6% 22% 7.3%

p ⬍0.05 ⬍0.05 ⬍0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05

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