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Robot-assisted radical prostatectomy in patients with locally-advanced prostate cancer
14th Meeting of the EAU Robotic Urology Section
PE09
Robot-assisted radical prostatectomy in patients with locally-advanced prostate cancer Eur Urol Suppl 2017; 16(6);e2262
Lakhno D. , Moscow Clinical Scientific Center, Dept. of Urology, Moscow, Russia Introduction & Objectives: Recent studies suggested that only surgical treatment or surgical treatment in combination, for example with antiandrogenic or radiotherapy, can achieve good oncological results in patients with locally advanced prostate cancer (PCa). However, now there are less reports in the literature concerning the results of robotic assisted prostatectomy (RARP) in patients with locally advanced prostate cancer. We analyzed our experience of RARP in patients with locally advanced PCa. Material & Methods: From February 2015, to April 2016 we performed RARP in 22 patients with locally advanced PCa (T3b-17 patients, T3a-5patients). All procedures were performed by using extraphascial technique in combination with extended pelvic lymph node dissection (up to ureter). On average, 16 l/n was removed. The medium age of the patients was 64.1 (53-74) year. The preoperative PSA values varied from 4.1 ng/ml to 133ng/ml (aver. 26.53 ng/ml). Pelvic MRI with contrast, osteoscintigraphy were performed in all patients, metastatic bone lesion were excluded. 7 (31,8%) patients with an average PSA level of 58.37 ng/ml (26.27-133ng/ml) received neoadjuvant hormonal therapy in the period from 2 to 6 months. Results: The mean blood loss was 280ml. There were no significant complications (Clavien-Dindo 3-5) in the postoperative period. Urinary incontinence rate after 1 year was 18% (4 of 22). Distribution on the Gleason scale: 6 (3 + 3) - 4; 7 (3 + 4) - 10; 7 (4 + 3) - 1; 8 (4 + 4) - 5; 9 (4 + 5) 1; and 10 (5 + 5) - 1 patient. Positive margin was detected in 4 (18%) patients, 3 patients underwent adjuvant radiation therapy, and in 4 immediate adjuvant hormonal therapy for 3-6 months. Oncological results were evaluated after 1 year (results of 20 patients were evaluated). Biochemical recurrence was detected in 2 patients, which was 10%. In 18 patients, PSA was in the range of 0-0.18 ng/ml (0.02 ng/ml). Conclusions: RARP allows to achieve good oncological control and high quality of life in patients with locally advanced PCa. And provide radical treatment for patients it was previously unavailable. The indications to multimodal approches requires further study and systematization of data.
Eur Urol Suppl 2017; 16(6);e2262
PE09
Robot-assisted radical prostatectomy in patients with locally-advanced prostate cancer Eur Urol Suppl 2017; 16(6);e2262
Lakhno D. , Moscow Clinical Scientific Center, Dept. of Urology, Moscow, Russia Introduction & Objectives: Recent studies suggested that only surgical treatment or surgical treatment in combination, for example with antiandrogenic or radiotherapy, can achieve good oncological results in patients with locally advanced prostate cancer (PCa). However, now there are less reports in the literature concerning the results of robotic assisted prostatectomy (RARP) in patients with locally advanced prostate cancer. We analyzed our experience of RARP in patients with locally advanced PCa. Material & Methods: From February 2015, to April 2016 we performed RARP in 22 patients with locally advanced PCa (T3b-17 patients, T3a-5patients). All procedures were performed by using extraphascial technique in combination with extended pelvic lymph node dissection (up to ureter). On average, 16 l/n was removed. The medium age of the patients was 64.1 (53-74) year. The preoperative PSA values varied from 4.1 ng/ml to 133ng/ml (aver. 26.53 ng/ml). Pelvic MRI with contrast, osteoscintigraphy were performed in all patients, metastatic bone lesion were excluded. 7 (31,8%) patients with an average PSA level of 58.37 ng/ml (26.27-133ng/ml) received neoadjuvant hormonal therapy in the period from 2 to 6 months. Results: The mean blood loss was 280ml. There were no significant complications (Clavien-Dindo 3-5) in the postoperative period. Urinary incontinence rate after 1 year was 18% (4 of 22). Distribution on the Gleason scale: 6 (3 + 3) - 4; 7 (3 + 4) - 10; 7 (4 + 3) - 1; 8 (4 + 4) - 5; 9 (4 + 5) 1; and 10 (5 + 5) - 1 patient. Positive margin was detected in 4 (18%) patients, 3 patients underwent adjuvant radiation therapy, and in 4 immediate adjuvant hormonal therapy for 3-6 months. Oncological results were evaluated after 1 year (results of 20 patients were evaluated). Biochemical recurrence was detected in 2 patients, which was 10%. In 18 patients, PSA was in the range of 0-0.18 ng/ml (0.02 ng/ml). Conclusions: RARP allows to achieve good oncological control and high quality of life in patients with locally advanced PCa. And provide radical treatment for patients it was previously unavailable. The indications to multimodal approches requires further study and systematization of data.
Eur Urol Suppl 2017; 16(6);e2262