(MP4-5) Outcomes of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy in our center
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  • 2015-11-30,
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低風險攝護腺惡性腫瘤經機器手臂腹腔鏡切除的預後:奇美醫院經驗分享
陳經國、沈坤宏、劉建良、黃冠華
奇美醫學中心 外科部 泌尿外科
Outcomes of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy in our center
Keng-Kok Tan, Kun-Hung Shen, Chien Liang Liu, Steven K. Huan
Division of Urology, Department of Surgery,
Chi Mei Medical Center, Taiwan
 
Purpose:
In prostate cancer, very low-risk tumors are often managed well with active surveillance, low to intermediate-risk tumors generally respond well to localized treatment (surgery or radiation alone, brachytherapy with or without external-beam therapy). Intermediate to high-risk tumors often require multimodal therapy (surgery with radiation, or radiation therapy with hormonal therapy). All available treatments for prostate cancer carry a risk of complications, side effects, and other impacts to the patient's long-term quality of life. Therefore, some practice suggested active surveillance in low-risk patient to avoid over treatment and complication. However, new surgical technique and instrument development, there can decrease surgical complication and improve patient outcome. We present the outcome of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy (RALRP) in our institution.
Materials and Methods:
From April 2012 to August 2015, 128 male patients with prostate cancer underwent RALRP in Chi Mei Medical Center. We follow the NCCN prostate cancer treatment guideline in our clinical practice. Patient characteristics, DRE, PSA, Gleason score, preoperative clinical staging, postoperative data and outcomes including final pathological staging, continence, potency, biochemical recurrence, postoperative complications and surgical margins were analyzed.
Results:
Only 7 patients are low risk group, the rest of 121 patients are intermediate, high and very high risk group. The average age of the low risk patients was 65.3 years(47~73). Pre-op mean PSA was 4.65 ng/ml (1.8~5.59), only 2 patients had palpable hard nodule while DRE, Gleason score were (3+3) in 6 patients and (2+2) in 1 patient. Post operation pathology showed margin free in all 7 cases, but 4 patients up-staging to T2c, 5 patients had total Gleason score 7 points and 6 patients shift to intermediate risk group compare to pre-op evaluation. After 6 weeks of surgery, PSA decrease to <0.01 ng/ml in all patient and during mean f/u times 19 months (9~33), no biochemical recurrence was noted.
Conclusion:
Although pre-op are low-risk group, but we found that more than half of the patient showed up-staging and up-grading after operation. Due to the robotic assisted system development, less complication and better outcome can be expected. May by operation can provided better oncology outcome in low-risk prostate cancer patient.
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    2015-11-30 13:45:00
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    TUA秘書處
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    台灣泌尿科醫學會
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