1464 ONCOLOGICAL OUTCOME OF RADICAL PROSTATECTOMY AS MONOTHERAPY FOR JAPANESE MEN WITH HIGH RISK PROSTATE CANCER

Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012

THE JOURNAL OF UROLOGY姞

e593

immediately underwent surgery, This was not the case as our cohort had the same outcomes when comparing them to men with similar parameters just prior to surgery who were not an on AS protocol.

% Gleason upgrading

Table 1 Study Group (n⫽41) 81.1

Control Group 1 (n⫽164) 46.3

p value .001 n.s. (p. ⫽ .1)

% pT3

24.4

12.8

% bilateral nerve sparing

75.6

93.9

.001

% positive margins

31.7

19.5

n.s. (p. ⫽ .1)

% biochemical recurrence

11.4 Study Group (n⫽41) 31.7

1.3 Control Group 2 (n⫽123) 35.0

.012 p value n.s. n.s.

% Gleason upgrading % pT3

24.4

20.2

% bilateral nerve sparing

75.6

84.2

n.s.

% positive margins

31.7

27.6

n.s.

% biochemical recurrence

11.4

5.7

n.s.

Source of Funding: None

Source of Funding: None

1464

1463 ROBOTIC RADICAL PROSTATECTOMY: BIOCHEMICAL RECURRENCE AND ONCOLOGIC OUTCOMES WITH 5 YEAR FOLLOW UP Michael Liss*, Kathyrn Osann, Douglas Skarecky, Achim Lusch, Blanca Morales, Thomas Ahlering, Orange, CA INTRODUCTION AND OBJECTIVES: Robot assisted radical prostatectomy (RARP) has demonstrated acceptable postoperative and early oncological outcomes. We present our initial series at least 5 years after surgery with a median follow up of ⬎5 years. METHODS: The study cohort was 436 consecutive patients undergoing RARP between 6/2002 and 9/2006. One patient who underwent post-radiotherapy salvage RARP and two with stage pT0 were excluded. Pathological and PSA data was prospectively entered and retrospectively reviewed. BCR was defined as (1) the time of any postoperative cancer treatment or (2) two persistent PSA values above 0.2 ng/ml. BCR free survival was estimated using Kaplan-Meier survival curves. The log rank test compares the event-time distributions for the comparisons of time to failure. Chi Square statistical analysis with a p value ⬍0.05 were considered significant. RESULTS: The mean age was 61.4 ⫾ 7.1(SD). The average time since surgery is 6.7 years and the median PSA follow is 5.4 years (range 1 - 110 months). 272 (63%) had ⱖ5 years follow-up; 391 (91%) had ⱖ2 years follow-up, 4 patients (1%) were lost and had no follow-up. The positive surgical margin rates for overall, pT2, and pT3 are 16%, 7%, and 37%, respectively. Overall survival was 95.2% (412/433); 4 died of CaP (0.92%) and 17 from other causes. The Overall K-M 3yr and 5yr estimates of BCRFS are 87.8% (SE⫽1.6%) and 84.9% (SE⫽1.8%). The K-M 5 year BCRFS estimates (Figure) by pGS are ⱕ6 97%, 7 81% and 8-10 43%. There were 312 (72%) patients with pT2 disease with 5yr-BCRFS of 94.6% (SE⫽1.4%) and a 5yr-PCSM of 0.3%. Pathologic T3 compromised 119 (27.5%) patients in which 5yr-BCRFS was 59.8% (SE⫽4.8%) and a 5 yr-PCSM of 2.5%. Two patients with pT4 disease were BCR-free at 53 and 51 months follow-up. To date 12 of the 17 pT2 BCRs (71%) have received secondary treatment versus 36/50 (72%) of pT3/4 patients with BCR. Median time to BCR was 1.5 years. CONCLUSIONS: These findings suggest that RARP produces similar oncologic outcomes grade for grade as has been reported for other academic open RP series with a median of 5 year biochemical recurrence free survival outcomes.

ONCOLOGICAL OUTCOME OF RADICAL PROSTATECTOMY AS MONOTHERAPY FOR JAPANESE MEN WITH HIGH RISK PROSTATE CANCER Junya Furukawa, Hideaki Miyake*, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) has been shown to result in excellent oncological outcomes for patients with low risk prostate cancer; however, it remains controversial whether RP as monotherapy can effectively control high risk prostate cancer. The objectives of this study were to retrospectively review our experience with RP as monotherapy for Japanese patients with high risk prostate cancer and to identify factors associated with biochemical outcome in these patients. METHODS: This study included a total of 382 consecutive patients who were diagnosed as having high risk prostate cancer according to D’Amico definition (PSA 20 ng/ml or greater, cT2c or greater, or biopsy Gleason score 8 –10), and subsequently underwent RP and pelvic lymphadenectomy without neoadjuvant therapy between 2001 and 2008. In this series, biochemical recurrence (BR) was defined as a serum PSA 0.2 ng/mL or greater on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached 0.4 ng/mL or greater. RESULTS: The median age and preoperative serum PSA in these 382 patients were 68 years (range, 54 –79 years) and 15.9 ng/ml (range, 2.9 – 65.4 ng/ml), respectively. Pathological examinations demonstrated that pathological stage was pT2, pT3 and pT4 in 195, 151 and 36, respectively, Gleason score was 6, 7 and 8 –10 in 40, 148 and 194, respectively, nodal status was pN0 and pN1 in 361 and 21, respectively, and surgical margin status was negative and positive in 201 and 181, respectively. During the observation period (median, 48.0 months), BR occurred in 134 of the 382 patients; however, there was no patient died of cancer progression. The 1-, 3- and 5-year BR-free survival (BRFS) rates were 79.2%, 68.4% and 60.1%, respectively. Among several factors examined, capsular invasion, seminal vesicle invasion and surgical margin status appeared to be independently associated with BRFS on multivariate analysis. Furthermore, there were significant differences in BRFS according to positive numbers of these three independent risk factors; that is, BR occurred in 21 of 140 patients who were negative for all risk factors (15.0%), 69 of 168 positive for a single risk factor (41.1%), and 45 of 74 positive for 2 or 3 risk factors (60.8%). CONCLUSIONS: These findings suggest that comparatively favorable cancer control could be achieved by RP as monotherapy for Japanese men with high risk prostate cancer; however, RP alone may not be insufficient in patients with positive for capsular invasion, seminal vesicle invasion and/or surgical margin. Source of Funding: None