Conclusions: RALP is a safe and feasible intervention with acceptable learning curve. After approx. 150 procedures negative surgical margins rise above 90% in the pT2 group. Regarding trifecta or PSA recurrence in combination with continence, our cohort of the first 400 procedures established no clear trend.
Conclusions: We assessed LNI in patients which underwent LPLND because of prostate cancer. In the low risk group none had LNI, in the intermediate risk group 13 (8%) patients had LNI and in the high risk group 59 (30.7%) patients had LNI.
18 Robot-assisted laparoscopic radical prostatectomy in patients with PSA levels ≥50 ng/ml. Surgical and oncologic outcomes Labanaris AP, Zugor V, Wagner C, Addali M, Witt JH. Urology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany Objectives: To assess the surgical and oncologic outcomes in patients with preoperative PSA levels ≥50 ng/ml undergoing robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). Materials & Methods: The records of N=36 men who underwent RALP from February 2006 to July 2011 were retrospectively reviewed. All patients had preoperative PSA levels ≥50 ng/ml. The parameters analyzed included: age, prostate size, PSA values, biopsy Gleason score, clinical stage, pathologic stage, Gleason score of specimen, lymph node status, positive surgical margins (PSM), percentage of PCa found in the specimen, blood loss, skin-to-skin operative time, intraoperative complications, minor and major complications, disease-specific mortality as well as biochemical progression in the follow up period, defined as PSA ≥0.2 mg/dl after nadir or never reached nadir.
17 Lymph node involvement after laparoscopic pelvic lymph node dissection: a retrospective analysis of 391 cases van Dooren VPM, Fossion LMCL. Urology, Maxima Medisch Centrum, Veldhoven, Netherlands Introduction: Despite current use of MRI for lymph node staging, pelvic lymph node dissection (PLND) is still the gold standard to stage patients with prostate cancer. The EAU guidelines define three risk groups of lymph node involvement (LNI): the low risk group is stage cT1-cT2a, has a Gleason score ≤ 6 and PSA < 10 ng/ ml; the intermediate risk group is stage cT2b-cT2c, has a Gleason score 7 and PSA 10-20 ng/ml; the high risk group is stage cT3a and above, has a Gleason score 8-10 and a PSA > 20 ng/ml.
Results: The median age of the patients was 63.6 years old, the median PSA was 86.1 mg/dl (range 50-220 mg/dl) and the median prostate size 42.1 ml. The clinical stage was thought to be confined in 77.7% of cases and locally extended in 22.3%. The Gleason biopsy score was Gleason <7 in 19.4% of patients, Gleason 7 in 41.6% and Gleason >7 in 38.9%. Intraoperative complications were encountered in N=5 patients (13.8%), N=3 bilateral ureter stent insertion and N=2 rectum injury. Minor postoperative complications were encountered in 25% of cases and major in 5.5%. The median operative time was 154 min and median blood loss 155 ml. The pathologic stage was T2 for 16.6% of patients, T3 for 41.6% and T4 for 41.6%. A Gleason <7 pattern was no longer evident, a Gleason 7 was evident in 41.6% of patients and a Gleason >7 in 58.3%. The percentage of PCa found in the prostate specimen was 63.6% and PSM were encountered in 41.6% cases. Lymph nodes were removed in all cases and were positive in 27.7% patients. N=30 patients (83.3%) underwent adjuvant therapy, with N=18 cases (60%) undergoing radiation therapy and N=12 (40%) hormonal treatment. After a median follow up of 23.6 months (range 3–52 months) no disease-specific mortality was evident but N=15 patients (41.6%) exhibited biochemical progression.
Methods: We analyzed 391 patients (325 (83.1%) in center one and 66 (16.9%) in center two) who underwent a laparoscopic pelvic lymph node dissection (LPLND) from January 2000 until March 2012 in two general hospitals located in the Netherlands. The LPLNDs were done according the current standard LND template and were performed by three urologists. 206 (52.7%) patients received an endoscopic extraperitoneal radical prostatectomy (EERPE) in combination with a LPLND. 33 (8.4%) patients were treated with brachytherapy, 111 (28.4%) patients with external beam radiation therapy (EBRT), 40 (10.2%) patients with hormonal therapy and one (0.3%) patient with high-intensity focused ultrasound (HIFU). Clinical stage, preoperative PSA, Gleason score and positive biopsy cores were assessed. Lymph node samples were assessed by two pathology centers. Center one assessed 325 lymph node samples and center two assessed 66 lymph nodes. We divided the groups according to the risk groups stated in the EAU guidelines for prostate cancer.
Conclusions: Our findings suggest that RALP can be performed in this cohort of patients. Nevertheless, patients should be informed of the suboptimal oncologic outcomes as well as that it is only one part of a multimodality therapy needed.
Results: Mean age was 65 years. Mean lymph node count was 11 LN. 72 (18.4%) patients out of the 391 patients had lymph node involvement (LNI). LNI was seen in 8 (6.3%) patients with clinical stage cT1-cT2a and LNI was seen in 64 (24,3%) patients with clinical stage ≥ cT2b. 34 (17%) patients with LNI had Gleason score < 6 and 38 (19.9%) patients with LNI had Gleason score > 6. LNI was seen in 11 (8.5%) patients with PSA < 10 and in 61 (23.4%) patients with PSA ≥ 10. None of the patients in the EAU low risk group had LNI. In the intermediate risk group 13 (8%) patients had LNI, in the high risk group 59 (30.7%) patients had LNI.
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