- Email: [email protected]
1749 LONG-TERM ONCOLOGICAL OUTCOMES OF LAPAROSCOPIC RADICAL PROSTATECTOMY
e676
THE JOURNAL OF UROLOGY姞
Factor Age
Univariate P ⬍0.001
65 or less
P -
⬎65
0.008
Preop Biopsy Gleason score
Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010
Multivariate Odds ratio
95% CI
referent 0.593
0.402-0.875
⬍0.001
6 or less(ref)
-
-
7
NS
-
8 or more
NS
-
-
-
carcinoma of the urinary bladder, renal cell carcinoma. Therefore, Prostate-cancer specific survival was 98.6% at 5 years and 97.8% at the end of the follow-up. The 8 patients who died from progression of prostatic cancer had pT3aGleason8, pT3aGleason9, pT3bGleason7, pT3bGleason9 and pT4Gleason9 tumors. CONCLUSIONS: In our cohort, biochemical and clinical recurrence-free survival rates are high after LRP, prostate cancer-specific mortality is very low. In patients with organ-confined disease, PSA elevation-free survival and clinical progression-free survival were significantly higher compared to patients staged pT3 or pT4.
Clinical T stage T2a or less(ref)
0.67
Source of Funding: None
T2b T2C or more PSA
0.001
10 or less(ref)
-
-
1750
10.1-20
NS
-
⬎20
NS
-
-
referent
ASSOCIATION OF POSTBIOPSY HEMORRHAGE OBSERVED ON PREOPERATIVE MAGNETIC RESONANCE IMAGING WITH SURGICAL DIFFICULTY FOR PERFORMING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY
Nerve sparing
⬍0.001
Bilateral Unilateral None Wet weight of prostate
0.505
0.337-0.757
⬍0.001
0.408
0.268-0.622
-
referent
⬍0.001
⬍50 50 or more Pathologic stage
0.001
0.009
0.647
0.466-0.897
⬍0.001
T2
-
referent
T3a
NS
0.936
0.566-1.549
T3b
⬍0.001
0.208
0.096-0.453
-
referent
Pathologic Gleason
⬍0.001
6 or less
Sung Kyu Hong*, Dae Sung Kim, Won Ki Lee, Hongzoo Park, Seung Hwan Doo, Seong Jin Jeong, Cheol Yong Yoon, Murodjone Abdullajanov, Seok-Soo Byun, Sung Il Hwang, Hak Jong Lee, Sang Eun Lee, Seongnam-si, Korea, Republic of
7
0.009
0.644
0.462-0.897
8 or more
0.000
0.256
0.133-0.493
Source of Funding: None
1749 LONG-TERM ONCOLOGICAL OUTCOMES OF LAPAROSCOPIC RADICAL PROSTATECTOMY Marcel Hruza*, Michael Schulze, Dogu Teber, Jens Rassweiler, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: Within 10 years, more than 2300 cases of laparoscopic radical prostatectomy (LRP) have been performed in the Heilbronn Department of Urology, one of the first centers in the world performing this procedure in daily clinical practice. To our knowledge, we are the first institution that presents an 8-years follow-up of a large cohort of patients after LRP. METHODS: 370 of our first 500 patients (74.0%) were available for long-term follow-up of at least 6 years. Median follow-up was 89 months (range 74-115). 120 of them even had a follow-up of more than 8 years. 59.7% were staged pT2, 21.4% pT3a and 18.9 % pT3b/pT4. RESULTS: At 24 months after surgery, the PSA elevation-free survival was 97.7%, 88.0% and 85.9% for pT2-, pT3a- and pT3b/pT4tumors respectively. At 60 months it was 88.3%, 68.0% and 60.9%, at 96 months it was 85.9%, 60.9% and 49.8% for the 3 groups mentioned above. Disease-free survival defined as absence of local or distant recurrence of the prostatic carcinoma at 24 months was 100.0% in pT2-, 94.7% in pT3a and 95.3% in pT3b/pT4-tumors. At 60 months, 97.7%, 88.0% and 78.1% disease-free survival were calculated for the 3 groups, at 96 months 97.2%, 84.4% and 78.1% of the patients were free of recurrence. Overall survival was 94.9% at 5 years and 93.2% at the end of the follow-up. 8 patients died from prostatic cancer, 17 died from other causes: Myocardial infarction (4 patients), plasmocytoma, pancreatic malignoma, aneurysm of a cerebral arteria, carcinoma of the liver (2 patients), carcinoma of the rectum, stroke (2 patients), malignoma of the oesophagus, brain tumor, cardiac death, transitional cell
INTRODUCTION AND OBJECTIVES: Due to lack of tactile feedback, dissection of surgical planes during delicate procedures of nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALRP) can be hampered more by postbiopsy hematomas or adhesions compared with open surgery. Meanwhile, magnetic resonance (MR) imaging for prostate cancer staging is usually performed after biopsy, and the extent of postbiopsy hemorrhage can be assessed via T1-weighted MR imaging. Thus, we investigated association between extent of postbiopsy hemorrhage observed via preoperative MR imaging with surgical difficulty of RALRP. METHODS: We reviewed records of 154 men who received prostate biopsy, MR imaging, and subsequently, nerve-sparing RALRP for clinically localized prostate cancer within two weeks of MR imaging. Patients who previously received biopsy or MR imaging at other institutions, hormonal therapy, radiation therapy, multiple (ⱖ 2) sessions of prostate biopsies, abdominal surgery, or prostate surgery before undergoing RALRP were excluded. Patients who preoperatively reported having urinary incontinence or International Index of Erectile Function (IIEF)-5 score ⱕ 10 were also excluded. We scored degree of postbiopsy hemorrhage as shown on T1-weighted MR imaging (hemorrhage score) and analyzed potential association of hemorrhage score with variables representative of surgical difficulty (operative time, estimated blood loss, and margin positivity) and functional outcomes (urinary continence and erectile function). RESULTS: Among our subjects, total hemorrhage score demonstrated no significant correlations with interval from biopsy to MR imaging (p ⬎ 0.05). In multivariate analyses, prostate volume and total hemorrhage score were observed to be significantly associated with operative time (p ⫽ 0.004 and 0.039, respectively) and estimated blood loss (p ⫽ 0.009 and 0.023, respectively). Patients⬘ age and total hemorrhage score was observed to be independent predictor of the return of erectile function sufficient for vaginal intercourse at 6 months following RALRP (p ⫽ 0.003 and 0.036, respectively). CONCLUSIONS: Our results show that the degree of postbiopsy hemorrhage observed in preoperative MR imaging may be predictive of surgical difficulty for performing RALRP. Such finding provides concrete evidences that aftereffects of prostate biopsy indeed have significant impact on performing RALRP. Source of Funding: None
THE JOURNAL OF UROLOGY姞
Factor Age
Univariate P ⬍0.001
65 or less
P -
⬎65
0.008
Preop Biopsy Gleason score
Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010
Multivariate Odds ratio
95% CI
referent 0.593
0.402-0.875
⬍0.001
6 or less(ref)
-
-
7
NS
-
8 or more
NS
-
-
-
carcinoma of the urinary bladder, renal cell carcinoma. Therefore, Prostate-cancer specific survival was 98.6% at 5 years and 97.8% at the end of the follow-up. The 8 patients who died from progression of prostatic cancer had pT3aGleason8, pT3aGleason9, pT3bGleason7, pT3bGleason9 and pT4Gleason9 tumors. CONCLUSIONS: In our cohort, biochemical and clinical recurrence-free survival rates are high after LRP, prostate cancer-specific mortality is very low. In patients with organ-confined disease, PSA elevation-free survival and clinical progression-free survival were significantly higher compared to patients staged pT3 or pT4.
Clinical T stage T2a or less(ref)
0.67
Source of Funding: None
T2b T2C or more PSA
0.001
10 or less(ref)
-
-
1750
10.1-20
NS
-
⬎20
NS
-
-
referent
ASSOCIATION OF POSTBIOPSY HEMORRHAGE OBSERVED ON PREOPERATIVE MAGNETIC RESONANCE IMAGING WITH SURGICAL DIFFICULTY FOR PERFORMING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY
Nerve sparing
⬍0.001
Bilateral Unilateral None Wet weight of prostate
0.505
0.337-0.757
⬍0.001
0.408
0.268-0.622
-
referent
⬍0.001
⬍50 50 or more Pathologic stage
0.001
0.009
0.647
0.466-0.897
⬍0.001
T2
-
referent
T3a
NS
0.936
0.566-1.549
T3b
⬍0.001
0.208
0.096-0.453
-
referent
Pathologic Gleason
⬍0.001
6 or less
Sung Kyu Hong*, Dae Sung Kim, Won Ki Lee, Hongzoo Park, Seung Hwan Doo, Seong Jin Jeong, Cheol Yong Yoon, Murodjone Abdullajanov, Seok-Soo Byun, Sung Il Hwang, Hak Jong Lee, Sang Eun Lee, Seongnam-si, Korea, Republic of
7
0.009
0.644
0.462-0.897
8 or more
0.000
0.256
0.133-0.493
Source of Funding: None
1749 LONG-TERM ONCOLOGICAL OUTCOMES OF LAPAROSCOPIC RADICAL PROSTATECTOMY Marcel Hruza*, Michael Schulze, Dogu Teber, Jens Rassweiler, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: Within 10 years, more than 2300 cases of laparoscopic radical prostatectomy (LRP) have been performed in the Heilbronn Department of Urology, one of the first centers in the world performing this procedure in daily clinical practice. To our knowledge, we are the first institution that presents an 8-years follow-up of a large cohort of patients after LRP. METHODS: 370 of our first 500 patients (74.0%) were available for long-term follow-up of at least 6 years. Median follow-up was 89 months (range 74-115). 120 of them even had a follow-up of more than 8 years. 59.7% were staged pT2, 21.4% pT3a and 18.9 % pT3b/pT4. RESULTS: At 24 months after surgery, the PSA elevation-free survival was 97.7%, 88.0% and 85.9% for pT2-, pT3a- and pT3b/pT4tumors respectively. At 60 months it was 88.3%, 68.0% and 60.9%, at 96 months it was 85.9%, 60.9% and 49.8% for the 3 groups mentioned above. Disease-free survival defined as absence of local or distant recurrence of the prostatic carcinoma at 24 months was 100.0% in pT2-, 94.7% in pT3a and 95.3% in pT3b/pT4-tumors. At 60 months, 97.7%, 88.0% and 78.1% disease-free survival were calculated for the 3 groups, at 96 months 97.2%, 84.4% and 78.1% of the patients were free of recurrence. Overall survival was 94.9% at 5 years and 93.2% at the end of the follow-up. 8 patients died from prostatic cancer, 17 died from other causes: Myocardial infarction (4 patients), plasmocytoma, pancreatic malignoma, aneurysm of a cerebral arteria, carcinoma of the liver (2 patients), carcinoma of the rectum, stroke (2 patients), malignoma of the oesophagus, brain tumor, cardiac death, transitional cell
INTRODUCTION AND OBJECTIVES: Due to lack of tactile feedback, dissection of surgical planes during delicate procedures of nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALRP) can be hampered more by postbiopsy hematomas or adhesions compared with open surgery. Meanwhile, magnetic resonance (MR) imaging for prostate cancer staging is usually performed after biopsy, and the extent of postbiopsy hemorrhage can be assessed via T1-weighted MR imaging. Thus, we investigated association between extent of postbiopsy hemorrhage observed via preoperative MR imaging with surgical difficulty of RALRP. METHODS: We reviewed records of 154 men who received prostate biopsy, MR imaging, and subsequently, nerve-sparing RALRP for clinically localized prostate cancer within two weeks of MR imaging. Patients who previously received biopsy or MR imaging at other institutions, hormonal therapy, radiation therapy, multiple (ⱖ 2) sessions of prostate biopsies, abdominal surgery, or prostate surgery before undergoing RALRP were excluded. Patients who preoperatively reported having urinary incontinence or International Index of Erectile Function (IIEF)-5 score ⱕ 10 were also excluded. We scored degree of postbiopsy hemorrhage as shown on T1-weighted MR imaging (hemorrhage score) and analyzed potential association of hemorrhage score with variables representative of surgical difficulty (operative time, estimated blood loss, and margin positivity) and functional outcomes (urinary continence and erectile function). RESULTS: Among our subjects, total hemorrhage score demonstrated no significant correlations with interval from biopsy to MR imaging (p ⬎ 0.05). In multivariate analyses, prostate volume and total hemorrhage score were observed to be significantly associated with operative time (p ⫽ 0.004 and 0.039, respectively) and estimated blood loss (p ⫽ 0.009 and 0.023, respectively). Patients⬘ age and total hemorrhage score was observed to be independent predictor of the return of erectile function sufficient for vaginal intercourse at 6 months following RALRP (p ⫽ 0.003 and 0.036, respectively). CONCLUSIONS: Our results show that the degree of postbiopsy hemorrhage observed in preoperative MR imaging may be predictive of surgical difficulty for performing RALRP. Such finding provides concrete evidences that aftereffects of prostate biopsy indeed have significant impact on performing RALRP. Source of Funding: None