Background:
Patients with intermediate/high risk localized prostate cancer remain a challenge with significant potential for primary treatment failure. Multiple methods have been developed for risk grouping, including probability tables, artificial neural networks and predictive nomograms. After patients’ stratification into low, intermediate and high risk localized prostate cancer, we retrospectively assessed the outcomes of robot-assisted laparoscopic extraperitoneal radical prostatectomy in patients with intermediate and high risk localized prostate cancer.
Methods:
Between July 2003 and April 2005, 298 patients were treated by robot-assisted laparoscopic extraperitoneal radical prostatectomy for clinically localized prostate cancer. Patients were categorized into risk groups, including intermediate risk: PSA 10 to 20 ng/ml, or Gleason sum 7, or secondary Gleason 4 or 5, or clinical stage T2b/c and high risk: PSA greater than 20 ng/ml, or Gleason sum greater than 7, or primary Gleason 4 or 5, or clinical stage T3a.
Results:
The study cohort included 298 patients, mean age 59.1 (42-76). 197 (66%), 93 (31%) and 8 (3%) were low, intermediate and high risk, respectively. All high risk and 79 (85%) of intermediate risk patients underwent bilateral pelvic lymphadenectomy.The mean operating time was 180 minutes (118-486), and the mean blood loss 208ml (25-1500). Average hospital stay was 1.3 days (0.4 to 3 days). Biochemical progression-free survival was in intermediate and high risk group 89% and 50% respectively. At 1, 3, and 6 months, the continence rates were 56%, 93%, and 96%, respectively. The potency rate was 60%.
Conclusions:
In our experience, robot-assisted laparoscopic extraperitoneal radical prostatectomy in patients with intermediate and high risk localized prostate cancer offered favorable oncologic and functional outcomes with decreased morbidity.
Table 1.
Clinico-pathological characteristic of 101 intermediate and high risk localized prostate cancer patients treated by robot-assisted laparoscopic extraperitoneal radical prostatectomy and oncological outcome.

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