Role of robot-assisted radical prostatectomy in the management of high-risk prostate cancer

Abstract

We aimed to evaluate the role of robot-assisted radical prostatectomy (RARP) in the management of high-risk prostate cancer (PCa), with a focus on oncological, functional and perioperative outcomes. Further, we also aimed to briefly describe our novel modification to conventional RARP that allows immediate organ retrieval and examination for intra-operative surgical margin assessment. A literature search of PubMed was performed for articles on the management of high-risk PCa. Papers written in English and concerning clinical outcomes following RARP for locally advanced and high-risk PCa were selected. Outcomes data from our own center were also included. A total of 10 contemporary series were evaluated. Biopsy Gleason score ≥ 8 was the most common cause for classification of patients into the high-risk PCa group. Biochemical failure rate, in the few series that looked at long-term follow-up, varied from 9% to 26% at 1 year. The positive surgical margin rate varied from 12% to 53.3%. Urinary continence rates varied from 78% to 92% at 1 year. The overall complication rates varied from 2.4% to 30%, with anastomotic leak and lymphocele being the most common complications. Long-term data on oncological control following RARP in high-risk patients is lacking. Short-term oncological outcomes and functional outcomes are equivalent to open radical prostatectomy (RP). Safety outcomes are better in patients undergoing RARP when compared with open RP. Improved tools for predicting the presence of organ-confined disease (OCD) are available. High-risk patients with OCD would be ideal candidates for RARP and would benefit most from surgery alone.

Analysis of outcome following robotic assisted radical prostatectomy for patients with high risk prostate cancer as per D′Amico classification

“…The overall continence rate among high-risk groups varies from 84% to 96% in various study groups. [ 5 ] Our rate is comparable with these results. This gives credence to the fact that high-risk group alone does not predispose to incontinence.…”

“…had postulated that the high-risk group undergoing RARP had a higher incidence of complications. [ 5 20 ] In our series, none of the patients had Clavien 3 or more complications.…”

“…Most of the series on high-risk prostate cancer with a large sample size have similar results. [ 5 ]…”

“…D’Amico's is the most commonly used, validated and cited risk stratification for prostate cancer. [ 5 ]…”

Long-term Cancer Control Outcomes in Patients with Clinically High-risk Prostate Cancer Treated with Robot-assisted Radical Prostatectomy: Results from a Multi-institutional Study of 1100 Patients

“…However, given the relative novelty of RARP, many surgeons are reluctant to use this procedure in patients with clinically high-risk PCa [9,10]. Consequently, only a handful of groups have reported on their experience of RARP in high-risk PCa patients, and even these groups have only reported on shortterm and perioperative outcomes [11,12]. To date, long-term cancer control outcomes following RARP in men with highrisk PCa remain poorly addressed.…”