Presentation Authors: Pratik Gurung*, Elizabeth Ellis, Jasmine Wood, Stephen Hassig, Changyong Feng, Ahmed Ghazi, Jean Joseph, Rochester, NY
Introduction: Data on long-term oncological and functional outcomes of robot-assisted laparoscopic prostatectomy (RALP) beyond 10 years are sparse. We aimed to interrogate our prospectively maintained database to outline the outcomes, in high-risk cases mandating long-term follow-up, with at least 10 years of follow-up.
Methods: Risk stratification to identify eligible cases was based on D&[prime]Amico risk at the outset and post-operative risk parameters (Gleason ≥8, â‰¥pT2c, pN1, positive surgical margin [PSM]). Survival analyses were performed by the Kaplan-Meier method. Cox proportional hazards modeling was used to evaluate prognostic factors for overall survival (OS), cancer-specific survival (CSS), biochemical relapse (BCR) and receipt of adjuvant/salvage treatment. Functional outcomes (Continence and Erectile dysfunction [ED]) were assessed comparing pre- and post-operative Questionnaires.
Results: Of 1348 patients who underwent RALP between July 2003 and August 2008, 461 high-risk cases with complete data were identified. Median [interquartile range, IQR] values were: Age of 60.9yrs [56.6 -65.7] and PSA of 5.9 [4.6-8.4], with a follow-up of 12.2yrs [11.3-13.4]. Of the high-risk cases: D&[prime]Amico high=49 (10.6%); â‰¥pT3 post-op=135 (29.3%), Gleason â‰¥8 post-op=38 (8.2%), PSM=70 (overall=15.2%, pT2=11%, pT3=25%), pN1=3 (1.4%). Biochemical relapse (BCR) was present in 109 (23.6%) cases. Age (p=0.011), Pathological Gleason (P < 0.001) and Stage (p=0.010) were predictive of BCR. Adjuvant or Salvage Radiotherapy was required in 63 (13.7%) cases. Overall, there were 57 (12.4%) deaths; 10 (2.17%) died of prostate cancer with a median survival of 8.3yrs.At the last follow-up, 421 (91%) of patients were completely dry [no pads]. Artificial urinary sphincter or male sling were required in 6 (1.3%) cases. Seven (1.5%) had required dilatation of bladder neck stricture. 132 (28.6%) patients were able to have intercourse pre- and post-operatively without any treatments. 175 (37.9%) men were able to have penetrative intercourse with/without treatment. Five (1.1%) required penile prosthesis.
Conclusions: In conclusion, RALP confers durable oncological outcomes beyond 10 years as prostate cancer specific (2.2%) and other-cause (10.2%) mortalities are relatively low. In this first study to also look at functional outcomes of RALP beyond 10 years, continence was excellent with around 9 in 10 (91%) men remaining completely dry. Around a third of men were continuing to have penetrative intercourse.