機械手臂輔助根除性攝護腺切除用於局部侵犯性晚期腫瘤的中長期追蹤

劉順琳¹、黃志平¹

中國醫藥大學附設醫院 泌尿部

Long term follow-up of Robotic Radical Prostatectomy for Locally Advanced Prostate Cancer

Shun-Lin Liu ¹、Chi-Ping Huang ¹

1 Department of Urology, China Medical University Hospital, Taichung, Taiwan

Background

The effectiveness of performing radical prostatectomy (RP) as the sole treatment for locally advanced prostate cancer has been a topic of debate due to the higher risk of complications and treatment-related morbidity in the past. However, with advancements in surgical techniques, particularly the introduction of Robotic Assisted Radical Prostatectomy (RARP), outcomes for patients with locally advanced prostate cancer have shown improvement. Previous studies have reported encouraging results, including strong biochemical control that has allowed for the delay of additional treatments. Considering this, we present our findings on the outcomes and long-term follow-up of RARP in the treatment of locally advanced prostate cancer (≥pT3 and any pTN1M0).

Methods

This retrospective review focused on patients with locally advanced prostate cancer who underwent Robotic Assisted Radical Prostatectomy (RARP) between January 2014 and December 2019 at China Medical University Hospital. The study, conducted by a single surgeon at a single center, included 44 patients with pathologic stages of pT3a, pT3b, pT4, or pTN1. Patient data was collected from the time of surgery until February 2024, capturing information on patient characteristics, perioperative outcomes, complications, adjuvant therapies, and follow-up results. Biochemical recurrence rate (BCR) was determined by monitoring PSA levels, with BCR defined as a rise in PSA exceeding 0.2 ng/dl after RARP. Survival status and BCR were assessed using Kaplan-Meier survival curves for analysis and presentation of the outcomes.

Results

 The patients in this study had an average age of 69.17 ± 6.73 years old and a median initial PSA (iPSA) of 26.76 ± 35.93 ng/mL. The median follow-up duration was 67.5 months. The median operative time was 205 minutes, and the average length of hospital stay was 7 days. The rates of biochemical recurrence (BCR) freedom and overall survival were 46% and 95%, respectively. Among the 23 patients who experienced BCR, 11 received salvage androgen deprivation therapy (ADT), 1 received salvage radiation therapy (RT) alone, and 8 patients received a combination of salvage ADT and RT. Three patients received ADT, RT, and novel hormonal agents (NHA) in combination. During the median follow-up of 67.5 months, 5 patients (11.6%) progressed to castration-resistant prostate cancer (CRPC), with 3 patients undergoing salvage RT and 1 patient receiving NHA treatment upon CRPC diagnosis. Among the 43 patients, 2 patients passed away during the follow-up period, resulting in an all-cause mortality rate of 4.6% and a cancer-specific mortality rate of 0%.

Conclusions

Patients diagnosed with locally advanced prostate cancer and undergoing primary robotic-assisted radical prostatectomy (RARP) exhibited a BCR-free rate of less than 50% over a median follow-up period of 67.5 months. Upon receiving salvage androgen deprivation therapy (ADT), radiation therapy (RT), or a combination of both, most patients remained classified as castration-sensitive prostate cancer (CSPC) during extended follow-up periods. RARP showcased favorable functional outcomes and a low incidence of complications in these individuals. Furthermore, it facilitated effective reduction of tumor burden and enabled precise pathological staging, thus potentially delaying the necessity for subsequent treatments without compromising overall survival rates.