Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom

Translated title of the contribution: Propensity score comparison of the various radical surgical techniques for high-risk prostate cancer

J. Busch, Mark L Gonzalgo, N. Leva, M. Ferrari, F. Friedersdorff, S. Hinz, C. Kempkensteffen, K. Miller, A. Magheli

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Introduction: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence. Patients and Methods: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models. Results: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant). Conclusion: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.

Translated title of the contributionPropensity score comparison of the various radical surgical techniques for high-risk prostate cancer
Original languageGerman
Pages (from-to)45-51
Number of pages7
JournalAktuelle Urologie
Volume46
Issue number1
DOIs
StatePublished - 2015

Keywords

  • high risk
  • laparoscopy
  • oncologic outcome
  • propensity score matching
  • prostate cancer
  • prostatectomy
  • robotic surgery

ASJC Scopus subject areas

  • Urology

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    Busch, J., Gonzalgo, M. L., Leva, N., Ferrari, M., Friedersdorff, F., Hinz, S., Kempkensteffen, C., Miller, K., & Magheli, A. (2015). Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom. Aktuelle Urologie, 46(1), 45-51. https://doi.org/10.1055/s-0034-1395562