Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer following neoadjuvant therapy: A propensity score-matched analysis

Abstract

Introduction & Objective: The treatment outcomes of robotassisted radical prostatectomy (RARP) and minimum incision endoscopic radical prostatectomy (MIE-RP) for high-risk prostate cancer following preoperative endocrine chemotherapy were studied retrospectively. Methods: In our department, RARP and MIE-RP were performed on 600 and 800 cases, respectively between 2005 and 2018. Of the total 1400 subjects, 556 (304 RARP; 252 MIE-RP) high risk prostate cancer patients underwent surgery after neoadjuvant therapy (ADT+low dose estramustine). Operation time, blood loss volume, Gleason score (GS), resection margin (RM), whether there was leakage from the anastomotic site, whether or not complications occurred, and recurrence based on prostate specific antigen (PSA) levels were compared between the two groups. Neoadjuvant therapy was administered for at least for 6 months before surgery. Results: In the RARP and MIE-RP groups, the mean age of the patients was 67.1 (50-77) years and 68.3 (47-78) years (p = 0.637). The mean PSA at the initial visit was 13.7 ng/mL (6.0-16.3) and 18.1 ng/mL (7.1-24.5) (p = 0.001). The mean operation times were 167 minutes (142-181) and 121 minutes (99-183), mean blood loss volumes 54mL (10-102) and 962mL (550-1228), respectively, showing significant differences between the two groups (p < 0.001). Both the RM-positive rate (RARP: 7.1% and MIE-RP: 10.2%) and the PSA recurrence rate (RARP: 3.3% and MIE-RP: 14.2%) were significantly lower in the RARP group (p < 0.001). Conclusions: As compared to MIE-RP, RARP for high-risk prostate cancer following preoperative endocrine chemotherapy was associated with longer surgical times, while the blood loss volume was significantly lower. Leakage from the anastomotic site and whether or notcomplications occurred did not differ between the two groups. Therefore, performing RARP with neoadjuvant therapy was considered to be safe. Furthermore, the RM-positive rate and the PSA recurrence rate were significantly lower, showing RARP to potentially play an important role as a highly radical surgery. (Figure Presented).