629 PERIOPERATIVE COMPLICATIONS OF RETROPUBIC RADICAL PROSTATECTOMY IN HIGH-RISK PROSTATE CANCER

629

Perioperative complications of retropubic radical prostatectomy in high-risk prostate cancer Twelker L., Fröhner M., Oehlschläger S., Leike S., Wirth M.P.



630

Are radical retropubic prostatectomy in obese patients an actual surgical challenge concerning objective parameters? Schoeler S., Witte A., Alschibaja M., Gschwend J., Paul R.

Technische Universität, Urology, Dresden, Germany Introduction & Objectives: To investigate the differences between low-, intermediateand high-risk carcinomas regarding perioperative complications in a recent series of retropubic radical prostatectomy (RRP). Material & Methods: From December 1992 to June 2005, 2029 RRPs including pelvic lymphadenectomy were performed at our institution by 6 surgeons. Results: Mean age was 64.8 years, mean PSA 11,86 ng/ml. 242 patients (11,9 %) have had a low risk cancer (PSA ≤10 ng/ml, Gleason ≤6, stage pT1 or pT2a), 934 (46 %) an intermediate risk (PSA >10 and ≤20 ng/ml and/or Gleason 7 and/or pT2b) and 853 (42,0 %) a high-risk cancer (PSA > 20 ng/ml and/or Gleason > 7 and/or stage ≥ pT2c). Margins were positive in 3.7 % of low-risk, 8.7 % of intermediate-risk and 30.8 % of high-risk carcinomas. n=2029

low-risk (n=242)

intermediaterisk (n=934)

high-risk (n=853)

mean operating time

163.4 min

159.5 min

165.7 min

gut injuries

2 (0.8 %)

6 (0.6 %)

8 (0.9 %)

ureteral injuries

0

1 (0.1 %)

3 (0.4 %)

lymphoceles requ. treatment

9 (3.7 %)

31 (3.3 %)

43 (5.0 %)

deep vein thrombosis

9 (3.7 %)

27 (2.9 %)

23 (2.7 %)

pulmonary embolism

1 (0.4 %)

10 (1.1 %)

5 (0.6 %)

impaired wound healing

9 (3.7 %)

23 (2.5 %)

31 (3.6 %)

mortality (30 days)

0

2 (0.2 %)

0

Technical University of Munich, Urology, Munich, Germany Introduction & Objectives: Is it only subjective feeling that obese patients are to be operated with more difficulty or are there any objective data, which can occupy this hypothesis? Material & Methods: 1545 patients with radical prostatectomy could be included into this retrospective analysis. The BMI was divided into 4 groups related to WHO. Univariate tests and Kaplan Meier analyses was performed to analyze the influence of the BMI on operability, morbidity, functional and onkological result. Concerning this matter hospital stay, duration of prostatectomy, rate of blood transfusion were as well evaluated as intra- and perioperative complications, postoperative rate of urinary continence function and PSA free survival. Results: The mean BMI was 25,2. Mean duration for prostatectomy was 187,5 min. and for group 3 (obesity) 193,9min. This small difference is statistically significant (p=0,002) between all groups. No differences between the transfusion rate (p=0,3) and the catheter period (p=0,14) were observed. The hospital stay was significantly different (p=0,004), whereby group 3 with 18,4d exhibited one day longer than group 1 (17,3d) and group 2 (17,4d). Intra- and perioperative complications were not different with exception of the rate of wound infections (p=0,0001). The postoperative urinary continence was identical for all groups (p=0,9). Concerning PSA free survival were no differences between all groups (p=0,5).

Conclusions: Retropubic radical prostatectomy is a safe procedure. Complications are not more frequent in patients with high-risk-carcinomas.

Conclusions: We did not find significant differences to operability, morbidity, functional and onkological result in dependence of the BMI with exception of the somewhat longer duration of prostatectomy and 1 day extended hospital stay of the obese patients, who suffered however more frequently postoperative wound infections.





631

Role of radical prostatectomy for high-risk localized prostate cancer Matsubara A.1, Teishima J.1, Yasumoto H.1, Usui T.1, Nakamoto T.2, Maruyama S.3

Hiroshima University, Urology, Hiroshima, Japan, 2Hiroshima City Asa Hospital, Urology, Hiroshima, Japan, 3Miyoshi Central Hospital, Urology, Miyoshi, Japan 1

Introduction & Objectives: To evaluate the potential of radical prostatectomy (RP) for high-risk localized prostate cancer. Material & Methods: We retrospectively reviewed the medical records of 304 consecutive patients who underwent RP and were followed up for a minimum of 1 year. Of these patients, 84 (28%) who had a prostate-specific antigen (PSA) value of >20 ng/ml and/or a biopsy Gleason score (GS) of 8 were selected and included in this study. Biochemical disease-free survival (BDFS), and disease-specific and overall survivals, were assessed using the Kaplan-Meier method. Predictors for BDFS were also assessed by Cox’s proportional hazards regression. PSA failure was defined as >0.2 ng/ml. Results: The median age of the 84 patients was 67 (range 54~75) years and the median PSA level was 17.3 (range 3.1~369) ng/ml. Forty-nine and 35 patients had cT1 and cT2, respectively. Biopsy GS was >8 in 60. Neoadjuvant hormonal therapy was administered in 25 (30%), with a median duration of 7 (range 2~52) months. Pathological results for the resected specimens were positive surgical margins (PSM) in 37/84 (44%), seminal vesicle invasion (SVI) in 14/84 (16%) and lymph node involvement in 2/73 (3%). Postoperatively, all the patients were followed up without adjuvant therapy until PSA failure, with a median observation period of 39 (range 12~129) months. The BDFS was 45% at 5 years of follow-up. The significant risk factors for PSA failure were cT2 (P=0.0442), PSA value >40 ng/ml (P=0.0003), biopsy GS >6, positive biopsy core rate (PBCR) >66% (P=0.0057), PSM (P=0.0153) and SVI (P=0.0004) (univariate log-rank test). Multivariate analysis revealed that a PSA value of <40 ng/ml and a PBCR of <66% were significant independent predictors for BDSF (P values and odds ratios for PSA failure were 0.0056 and 0.0738, and 0.0264 and 0.1737, respectively). In patients with both factors, the BDFS at 5 years of follow-up was 59%. The disease-specific and overall survivals for the 84 patients were 96% and 92% at 5 years of follow-up, respectively. Conclusions: RP provides favorable cancer control even for high-risk patients under certain conditions, and should therefore be considered as a treatment option for such patients.

Eur Urol Suppl 2007;6(2):180

632

Prognostic factors for prostatic cancer patients with high gleason score who underwent radical prostatectomy Tomita K., Tsurumaki Y., Kume H., Fukuhara H., Takeuchi T., Kitamura T. University of Tokyo, Urology, Tokyo, Japan

Introduction & Objectives: Prognosis of prostatic cancer patients with gleason score 8 or greater is relatively poor. The prognosis of those patients who underwent radical prostatectomy is not clear. Whether or not those patients need adjuvant therapy after the operation is also unclear. We estimate the correlation between clinicopathological factors and prognosis in prostatic cancer patients with high gleason score who underwent radical prostatectomy. Material & Methods: We evaluated 86 prostatic cancer patients with high gleason score out of 447 patients with prostatic cancer who underwent radical prostatectomy between 1984 and 2005. The mean age at operation was 65.8 years (ranged from 52 to 77). Total follow-up ranged from 5 to 173 months (mean 55.4 months). We estimate the correlation between clinicopathological factors and prognosis in the patients on univariate and multivariate analyses. Results: Average of preoperative PSA level was 27.8ng/ml (2.3-165). 19 patients (22.1%) received neoadjuvant androgen deprivation therapy and 61 (70.9%) received adjuvant androgen deprivation therapy. 10 years cause specific survival rate was 75.4% in the all patients.　The ratio of 10-years survival rate for each variable and p value on univariate analysis were as follows: PSA level (<10: 69.2%, 10-20:66.7%, >20: 85.7%, p=0.931), pT stage (pT2: 100%, pT3,4: 81.7%, p=0.535), lymph node metastasis (negative: 82.7%, positive: 63.5%, p=0.196), Gleason score (8: 100%, 9 and 10: 63.5%, p=0.084), seminal vesicle invasion (negative: 75.0%, positive: 72.6%, p=0.081), lymph or vessel invasion (negative: 75.0%, positive: 76.8%, p=0.565), cancer cell penetration of the prostatic capsule (negative: 100%, positive: 72.6%, 9=0.016) and surgical margin (negative: 91.7%, positive: 72.2%, p=0.696). The proportional hazard regression model revealed positive cancer cell penetration of the prostatic capsule had a tendency to be a worse prognostic factor for prostatic cancer patients with high gleason score who underwent radical prostatectomy (p=0.056). Conclusions: Our data revealed positive cancer cell penetration of the prostatic capsule was a worse prognostic factor for prostatic cancer patients with high gleason score who underwent radical prostatectomy.