NEAUA 79th Annual Meeting Abstracts

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Introduction
Patients with higher risk prostate cancer based on D’Amico criteria experience worse rates of biochemical recurrence-free survival following radical prostatectomy (RP). Various treatment methods have been employed prior to RP to improve survival including neoadjuvant hormone or neoadjuvant chemotherapy; however, the role of NCRP and patient selection remains largely unknown. We review our experience with NCRP and compare outcomes to controls with intermediate and high-risk prostate cancer undergoing RP alone.
Methods
From 7/2000 to 5/2006, 82 men with intermediate and high-risk disease received neoadjuvant chemotherapy with different combinations of docetaxel, bevacizumab, imatinib, or estramustine then underwent open RP at the Brigham and Women’s Hospital or Beth Israel Deaconess Medical Center as part of clinical protocols. Pathologic, perioperative and short-term cancer control outcomes were compared to 59 men with intermediate and high-risk disease features undergoing RP alone during the same time frame by the same surgeons.
Results
Men undergoing NCRP vs. RP were less likely to receive nerve-sparing (47.5% vs. 89.8%, p<0.001), experienced longer operative times (254 vs. 187 min, p<0.001), and longer hospital stays (3.1 vs. 2.3 days, p=<0.001). Intraoperative blood loss was similar (625 vs. 750 mL, p=0.148); however, NCRP vs. RP was associated with more blood transfusions (86.6% vs. 6.8%, p=<0.001). There were 3 vs. 0 intraoperative complications for NCRP vs. RP including 2 rectal injuries and 1 ureteral injury, otherwise rates of other complications were similar and rare (<5% in either group). Additionally, NCRP vs. RP subjects were more likely to have ≥pT3 disease (56.2% vs. 23.7%, p<0.001) and positive surgical margins (36.6% vs. 15.3%, p=0.005). Finally, NCRP vs. RP subjects had a higher risk of PSA recurrence (35.7% vs. 8.3%, p=0.007) and greater subsequent use of additional radiation and/or hormonal therapy (46.3% vs. 12.0%, p<0.001).
Conclusion
NCRP vs. RP was associated with longer operative times, length of stay, and greater perioperative morbidity, it did not appear to improve surgical margin rates or short-term cancer control. These differences may be related to the worse baseline risk features in patients undergoing NCRP vs. RP. With the development of novel targeted prostate therapies in prostate cancer, NRCP remains a viable treatment paradigm albeit with potentially increased morbidity.

Comparison of Perioperative Outcomes of NCRP and RP

	NCRP, n=82	RP, n=59	p-value
Nerve Sparing			<0.001
None	43 (52.4%)	6 (10.2%)
Unilateral	38 (46.3%)	42 (71.2%)
Bilateral	1 (1.2%)	11 (18.6%)
Median Operative Time (min)	254	187	< 0.001
Median EBL (mL)	625	750	0.098
Any Blood Transfusions	71 (86.6%)	4 (6.8%)	<0.001
Postoperative Blood Transfusions	6 (7.3%)	0	0.034
Mean Hospital Stay (days)	3.1	2.3	0.002

Comparison of Operative Complications in NCRP and RP

	NCRP, n=82	RP, n=59	p-value
Rectal Injury	2 (2.5%)	0	0.233
Ureteral Injury	1 (1.2%)	0	0.395
Urinary Retention	4 (4.9%)	2 (3.4%)	0.666
Anastomotic Stricture	4 (4.9%)	3 (5.1%)	0.956
Delayed Urine Leak	1 (1.2%)	0	0.395
Postoperative Hypotension	3 (3.7%)	1 (1.7%)	0.488
Postoperative DVT/PE	1 (1.2%)	0	0.395
Pronlonged Hematuria	0	2 (3.4%)	0.093
Postoperative UTI	0	2 (3.4%)	0.093

Comparison of Positive Surgical Margins, Recurrence, Adjuvant therapy in NCRP and RP

	NCRP, n=82	RP, n=59	p-value
Positive Surgical Margin	30 (36.6%)	9 (15.3%)	0.005
Patients with undetectable PSA postoperatively	70 (86.4%)	48 (98%)	0.030
Patients with Biochemical Recurrence	25 (35.7%)	4 (8.3%)	0.0007
Recieved Any Adjuvant Therapy	38 (46.3%)	7 (12.0%)	<0.001
Recieved Adjuvant XRT + ADT	22 (26.8%)	4 (6.8%)	0.003
Recieved Adjuvant XRT	7 (8.5%)	1 (1.7%)	0.083
Recieved Adjuvant ADT	8 (9.8%)	2 (3.4%)	0.146
Recieved Adjuvant Chemotherapy	6 (7.3%)	0	0.034
Mean Nadir PSA	0.68	1.53	0.451