Extraperitoneal laparoscopic radical prostatectomy (ELRP) is safe and effective for treating localized prostate cancer, data suggest.
Alexandre Paul, MD, and colleagues at Hospital Henri Mondor in Créteil, France, studied 1,115 men who underwent the procedure, which has been the standard surgical technique for localized prostate cancer at their institution since 2000. The median post-operative follow-up was 35.6 months.
The overall PSA recurrence-free survival was 83% at five years. The five-year progression-free survival rates were 93.4% for pT2, 74.5% for pT3a, and 55% for pT3b tumors, respectively, the investigators reported in European Urology (2009; published online ahead of print). Biochemical recurrence, defined as a PSA level of 0.2 ng/mL, occurred in 146 men (13%).
Additionally, the team found that PSA, Gleason score, pT category, nodal status, and surgical margins were significant independent predictors of biochemical recurrence-free survival. The five-year recurrence-free survival rate was 86.7%, 69.8%, and 47.5% for men with preoperative PSA levels below 10, 10-20, and 20 ng/mL or higher, respectively.
Compared with patients with a preoperative PSA level below 10, those with levels of 10-20 had a nonsignificant 24% increased risk of biochemical recurrence whereas men with a PSA level of 20 or higher had a significant 2.9 times increased risk.
Compared with men who had a Gleason score below 7, those with a Gleason score above 7 had a fourfold increased risk of recurrence. A Gleason score of 7 was associated with a nonsignificant 28% increased risk. Positive lymph nodes and positive surgical margins were associated with a 5.6 times and 2.7 times increased risk, respectively.
Patients with a Gleason score above 7 had a five-year progression-free survival rate 36% versus 82.8% and 93.5% for patients with Gleason scores of 7 and less than 7, respectively. Patients with positive surgical margins had a five-year progression-free survival rate of 56.6% compared with 89% for men with negative surgical margins.
“On the basis of midterm follow-up data,” the authors concluded, “the prognostic factors of PSA after ELRP failure are the same as those described previously in transperitoneal or open retropubic approaches. The oncologic results of ELRP also are in line with those reported with the use of the retropubic or the transperitoneal laparoscopic approaches.”