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Neoadjuvant chemohormonal therapy followed by robot-assisted and minimum incision endoscopic radical prostatectomy in patients with high-risk prostate cancer: comparison of perioperative and oncological outcomes at single institution

  • Urology - Original Paper
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Abstract

Purpose

Optimal management strategies for patients with high-risk prostate cancer (PCa) have not been established. This study aimed to estimate the impact of surgical procedures on perioperative and oncological outcomes in patients with high-risk PCa who received neoadjuvant chemohormonal therapy (CHT) prior to radical prostatectomy (RP).

Methods

In this retrospective study, we focused on patients with high-risk PCa who received neoadjuvant CHT followed by RP. The enrolled patients were divided into the following two groups according to surgical procedure: the robot-assisted RP (RARP) group and minimum incision endoscopic RP (MIE-RP) group. The primary endpoint was biochemical recurrence-free survival (BRFS).

Results

A total of 522 high-risk PCa patients were enrolled in this study. The median operating time was significantly shorter in the MIE-RP group than in the RARP group. The median estimated blood loss was significantly lower in the RARP group than in the MIE-RP group. The rates of positive surgical margins (PSMs) were not statistically significant in either group. During the follow-up period, biochemical recurrence (BCR) without clinical recurrence occurred in 60 (23.9%) patients in the MIE-RP group and 5 (1.8%) in the RARP group. The 5-year BRFS rate was 76.5% in the MIE-RP group and 97.6% in the RARP group (P < 0.001). On multivariate analysis, RARP, PSM, pathological T stage, and initial prostate-specific antigen were significantly associated with BCR.

Conclusions

Neoadjuvant CHT with subsequent RARP may decrease the risk of BCR when compared to MIE-RP.

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Acknowledgements

This study was supported by the following grants-in-aid for Scientific Research from the Japan Society for the Promotion of Science: 15H02563 (to CO), 15K15579 (to CO), and 17K11118 (to TK).

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Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5-Zaifucho, Hirosaki, 036-8562, Japan

    Naoki Fujita, Takuya Koie, Yasuhiro Hashimoto, Takuma Narita, Yuki Tobisawa, Toshikazu Tanaka, Daisuke Noro, Masaaki Oikawa, Kazuhisa Hagiwara, Tohru Yoneyama, Atsushi Imai, Hayato Yamamoto, Shingo Hatakeyama, Takahiro Yoneyama & Chikara Ohyama

Authors
  1. Naoki Fujita
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  2. Takuya Koie
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  3. Yasuhiro Hashimoto
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  4. Takuma Narita
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  5. Yuki Tobisawa
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  6. Toshikazu Tanaka
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  8. Masaaki Oikawa
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  9. Kazuhisa Hagiwara
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  12. Hayato Yamamoto
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  13. Shingo Hatakeyama
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  14. Takahiro Yoneyama
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  15. Chikara Ohyama
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Corresponding author

Correspondence to Takuya Koie.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation. The study information was open for the public consumption at http://www.med.hirosaki-u.ac.jp/~uro/html/IRB/IRBdoc.html.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Fujita, N., Koie, T., Hashimoto, Y. et al. Neoadjuvant chemohormonal therapy followed by robot-assisted and minimum incision endoscopic radical prostatectomy in patients with high-risk prostate cancer: comparison of perioperative and oncological outcomes at single institution. Int Urol Nephrol 50, 1999–2005 (2018). https://doi.org/10.1007/s11255-018-1985-8

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  • DOI: https://doi.org/10.1007/s11255-018-1985-8

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