高風險和非常高風險攝護腺癌病人接受達文西機械手臂根除性攝護腺切除術的腫瘤與功能性預後

陳維心、江元宏、郭漢崇

花蓮慈濟醫院 泌尿科

Oncological and Functional Outcomes in High Risk and Very High Risk Prostate Cancer Patients Receiving Robotic-Assisted Radical Prostatectomy

Wei-Hsin Chen, Yuan-Hong Jiang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

Purpose: To evaluate the oncological and functional outcomes in high risk and very high risk localized prostate cancer patients receiving robot-assisted radical prostatectomy (RaRP)

Materials and Methods: One hundred localized prostate cancer patients who underwent RaRP from August 2015 to December 2020 were retrospectively enrolled. Enrolled patients were classified into two groups: below high risk group, and high risk/ very high risk group. They were closely followed up with serum PSA for biochemical recurrence (BCR). Among them, seventy-one had documented functional outcomes reporting postoperative stress urinary incontinence (SUI) within one year after RaRP.

Results: The mean age of enrolled patients was 69.7±7.4 years with a median follow-up of 26.4 (3.2-71.3) months. Among them, 53%, and 47% patients were below high risk group, and high risk/very high risk group, respectively.  Perioperatively, operation time and blood loss did not differ between two groups. Median BCR-free survival of the entire cohort was 53.1 months. BCR-free survival of high risk/ very high risk group with adjuvant treatment was similar to that of below high risk group, but higher than that of high risk/ very high risk group without adjuvant treatment (median 60.5mo, 53.1mo, and 20.6 mo, p < 0.0016).  Among patients with documented functional outcomes, 38 (53.5%), and 33 (46.5%) patients were below high risk group, and high risk/ very high risk group, respectively. Overall, the rate of immediate SUI after RaRP was 50.7%, and the rate of SUI trended down to 43.7%, and 8.5% at postoperative 1 month, and 12 months, respectively. High risk/ very high risk group had a significantly higher rate of immediate SUI (75.8% v.s. 28.9%) and SUI at postoperative 1 month (63.6% v.s. 26.3%) (both p< 0.01).  Yet, the rates of SUI after RaRP did not differ between two groups from postoperative 3 months to 12 months. The factor of high risk/ very high risk group was a predictor of immediate SUI but not for long-term SUI after RaRP.

Conclusions: High risk and very high risk prostate cancer patients receiving both RaRP and adjuvant treatment had comparable oncological outcomes to below high risk prostate cancer patients. The factor of high risk/ very high risk prostate cancer impeded the early recovery, but not the long-term recovery of continence after RaRP. RaRP is a safe and feasible option in high risk and very high risk prostate cancer patients.