Predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy: Analysis of 359 cases with a median follow‐up period of 26 months

Abstract

Objectives Our aim was to evaluate the predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy. Methods The study cohort consisted of 359 consecutive non‐metastatic prostate cancer patients who underwent Retzius‐sparing robot‐assisted radical prostatectomy between November 2012 and January 2016. According to the National Comprehensive Cancer Network prostate cancer risk classification, 164 patients (45.7%) had high‐ or very high‐risk prostate cancer. No patient received adjuvant therapy until documented biochemical recurrence. Biochemical recurrence‐free survival was estimated using the Kaplan–Meier method. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of biochemical recurrence. Results The median follow‐up period was 26 months (interquartile range 19–38 months). The overall biochemical recurrence rate was 14.8%, and the median time to biochemical recurrence was 11 months (interquartile range 6–22 months). The 3‐year biochemical recurrence‐free survival probability was 71.2%, 72.1%, 88.7%, 82.3% and 95.7% in very high‐, high‐, intermediate‐, low‐ and very low‐risk prostate cancer, respectively (log–rank, P < 0.001). On multivariable analysis, preoperative prostate‐specific antigen (hazard ratio 1.03, 95% confidence interval 1.02–1.04; P < 0.0001), percentage of maximum core involvement on biopsy (hazard ratio 1.02, 95% confidence interval 1.01–1.03; P = 0.029) and clinical stage ≥T3a (hazard ratio 2.12, 95% confidence interval 1.02–4.39; P = 0.043) were predictors of biochemical recurrence, whereas pathological Gleason score ≥8 (hazard ratio 5.63, 95% confidence interval 1.62–19.61; P = 0.007) and pathological tumor volume (hazard ratio 1.08, 95% confidence interval 1.04–1.20; P < 0.001) were the main pathological predictors of biochemical recurrence. Conclusions Retzius‐sparing robot‐assisted radical prostatectomy confers effective biochemical recurrence control at the mid‐term follow‐up period. Preoperative prostate‐specific antigen, advanced clinical stage and higher Gleason score were important predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy. Long‐term oncological safety still needs to be established.

Reply: Retzius‐sparing robot‐assisted radical prostatectomy (RARP) vs standard RARP

“…Recently, our group reported the mid‐term oncological outcomes of patients with high‐risk PCa treated with RS‐RARP and these were similar to those of large studies of conventional RARP. This confirms effective and safe mid‐term BCR control after RS‐RARP, while the long‐term oncological results are awaited . Currently, > 4 000 cases of RS‐RARP are performed worldwide and more centres are beginning to use and converting to Retzius‐sparing surgery.…”

“…Overall, the positive surgical margin (PSM) rate was 30.6% (14.6% in pT2 and 40.8% in pT3a disease) and the BCR rate was 14.8%. In terms of functional outcomes, the urinary continence rate at 1 year was 93.9% . Interestingly, 164 patients (45.7%) of our cohort had high‐risk PCa.…”

“…In studies that used the D'Amico criteria the median follow‐up ranged from 12.5 to 37.3 months, the PSM rates were 20.5% to 53.3%, the BCR rates were 17.4% to 31% and the 3‐year BCRFS rates were 41.4% to 86%. In studies that used the National Comprehensive Cancer Network criteria, the median follow‐up ranged from 23.6 to 27 months, the PSM rates were 29% to 38%, the BCR rates were 9.4% to 33%, and the 3‐year BCRFS rates were 55% to 66% [ ] .…”

Editorial Comment to Predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy: Analysis of 359 cases with a median follow‐up period of 26 months

“…In the present study, Abdel Raheem et al . reported the evaluation of biochemical recurrence after RS‐RARP . The midterm oncological outcomes (median follow up, 26 months) of 359 patients undergoing RS‐RARP were investigated in this report, and the outcomes of cancer control were comparable with those of conventional RARP.…”

Signature Panel of 11 Methylated mRNAs and 3 Methylated lncRNAs for Prediction of Recurrence-Free Survival in Prostate Cancer Patients

“…1 Radical prostatectomy is considered as the first-line treatment option for PCa patients, but recurrence (biochemical, BCR; or clinical) frequently occurs in 10-40% of patients after curative surgery, [2][3][4] which leads to the cumulative 5-year recurrence-free survival (RFS) rate of only about 65%. 3,5 Clinically, prostate-specific antigen (PSA) level, 6 Gleason score, 7 and tumor, node, metastasis (TNM) staging 8 are widely used to predict tumor recurrence. Nevertheless, their prediction accuracy remains unsatisfactory (<70%).…”