Is robotic­ assisted prostate surgery a suitable treatment for high-risk prostate cancer?

This study examined robotic ­assisted radical prostatectomy (RARP) in the treatment of high-risk localized prostate cancer. Researchers reported that the number of risk factors did not increase the risk of cancer recurrence after RARP.

Prostate surgery (also called radical prostatectomy) is a common treatment for localized (confined) prostate cancer. Robotic­ assisted radical prostatectomy (RARP) has allowed for more accurate and careful removal of the prostate, seminal vesicles (glands that create semen), and lymph nodes (sites that contain the immune cells) with minimal damage to surrounding tissue. RARP has been associated with good treatment outcomes and reduced complication rates.

High-risk prostate cancer patients are at increased risk of cancer recurrence after treatment. High PSA (prostate specific antigens; a protein elevated in the blood in prostate cancer), high tumor stage, and tissue samples indicating aggressive cancer cells (Gleason score of 8 to 10) can each increase cancer recurrence risk. For men with high-risk localized prostate cancer, wide resection during prostate surgery is often recommended. This involves removing a larger section of the tumor and surrounding tissue for maximum cancer control. Whether RARP is a suitable treatment option for men with high-risk prostate cancer is still under investigation. 

The aim of this study was to examine treatment outcomes of RARP in men with high-risk prostate cancer.

The records of 90 men with high-risk localized prostate cancer were analyzed. 55.6% of men were at high-risk due to high PSA levels. 33.3% of men were at high-risk due to Gleason score of 8 or above. 42.2% of men were at high-risk due to tumor stage (stage 2c and above). Some men (27.8%) presented with more than one risk factor. All men underwent treatment with RARP. Treatment outcomes were followed for an average of 14.9 months.

29.7% of men had cancer recurrence after treatment. There was also one prostate cancer-related death during the study follow-up. 34.4% of men required additional treatment after RARP. Men with more than one risk factor were significantly more likely to have locally advanced prostate cancer (tumor spreading into nearby tissue). However, the number of risk factors did not significantly increase the risk of cancer recurrence.

The overall complication rate was 5.5%. No serious complications were noted. One patients required a blood transfusion during the RARP procedure. The average time spent in hospital after the procedure was 2.5 days. 92% of men were continent 1 year after RARP.

Researchers concluded that cancer recurrence and complication rates following RARP were acceptable in the treatment of high-risk localized prostate cancer. However, researchers advise that better risk classification methods are needed.