Robotic radical prostatectomy as the initial step in multimodal therapy for men with high-risk localised prostate cancer: initial experience of 160 men.

摘要: Objectives • To report the outcome of robotic-assisted laparoscopic radical prostatectomy (RALP) for men with localised high-risk prostate cancer at diagnosis. Although commonly managed by radiotherapy (RT) prolonged androgen-deprivation therapy (ADT), we hypothesize that initiation multimodal RALP is oncologically efficacious and may allow many to avoid ADT. Patients methods Between December 2003 September 2010, 1480 underwent whom 160 fulfilled National Comprehensive Control Network criteria disease (prostate-specific antigen (PSA) > 20 ng/mL and/or clinical stage, cT ≥ 3 biopsy Gleason score 8). Biochemical recurrence (postoperative PSA 0.2) was used assess after monotherapy. Treatment failure defined as either a rising level salvage RT or Results The mean age ± standard deviation 63.1 6.3 years. Median 9.95 (interquartile range 6.0-21.4). Analysis specimen showed 8-10 cancers in 65 (41%), extracapsular disease, pT 3, 96 (60%) which seminal vesicle invasion evident 36 (23%). Downgrading occurred 64 (40% total group) five (3%) were downstaged pT2 disease. By contrast, any upgrading 29 (18% upstaging 68 (43%). overall positive surgical margin rate 38%, correlating stage (15%) pT3 (53%). With median follow-up 26.2 months 5.5-37.3), two non-cancer-related deaths have (overall survival 98.8%; cancer-specific 100%), biochemical has 53 (33%). surgery served monotherapy (n= 117, 73%), been followed 24, 15%) ADT 43, 27%). Overall 2-year 3-year treatment 31 41%, respectively. Serum only independent predictor (hazard ratio [HR] 1.02, P= 0.001) although strong trend observed both (HR 1.22, 0.058) number cores on transrectal 1.06, 0.057). Conclusions incorporating use postoperative good management strategy this aggressive variant cancer. At excess 2 years, found low rates enabling high proportion remain free