Evaluating the effectiveness of extended robot-assisted prostate surgery and extended pelvic lymph node dissection in patients with very high-risk prostate cancer.

This study analyzed the effectiveness of extended robotic-assisted laparoscopic prostatectomy (eRALP) with extended pelvic lymph node dissection (ePLND) without any other additional treatments for patients with very-high-risk localized prostate cancer (PCa). The study found that eRALP with ePLND alone was safe and effective for some patients.

Localized PCa is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. Men with PCa usually have high levels of prostate-specific antigen (PSA). PSA is a protein made by the cells of the prostate gland. Patients with very-high-risk PCa (VHRPCa) have earlier biochemical recurrences (BCRs) and lower survival rates after radical prostatectomy (RP; prostate removal surgery). BCR means an increase by 0.2 ng/ml from the lowest value of the PSA.

ePLND is surgery to remove the lymph nodes from the pelvis. It is often used in combination with RP for the treatment of patients with VHRPCa. eRALP is a type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo RALP surgery commonly have less blood loss and shorter hospital stays. Patients with VHRPCa usually have other treatments such as hormonal or chemotherapy before and/or after surgery to shrink the cancer and to kill any cancer cells that may have remained after surgery. However, there are few studies evaluating the effectiveness of eRALP with ePLND alone for the treatment of patients with VHRPCa.

This study involved 76 patients with VHRPCa who were treated with eRALP surgery with ePLND. The average follow-up time was 25.2 months.

The average time of the surgery was 246 mins. The average blood loss was 50 mL. 27.6% of patients experienced complications after surgery. 19.7% of patients had treatment failure.

After 3 years, 62% of patients were free from BCR. After 3 years, 86.1% of patients were alive without any signs of PCa. All patients (100%) were alive after 3 years.

85.5% of the patients achieved urine continence (ability to control urine without leakage) within 12 months.

Patients with a clinical stage of cT3b-T4 were 5.45 times likely to experience treatment failure. Patients with cancer cells present in the lymph nodes were 2.44 times likely to experience BCR.  

This study concluded that eRALP with ePLND alone was safe and effective for some patients with VHRPCa.

This study looked back in time at medical records. This study included a small number of participants and the follow-up period was also short.