Department of surgery division of urology
centre hospitalier de l'université de Montreal
The oncological and pathological outcomes of prostate cancer patients undergoing delayed robotic-assisted radical prostatectomy after initial management by active surveillance
Ali Abdullah1, Ahmed AZ Zakaria1, David-Dan DN Nguyen2, Iman IS Sadri2, Adel AA Arzeki2, Joelle JV Vincelli1, Assaad AE El-Hakim3, Kevin KZ Zorn1.
1Department of Surgery Division of Urology, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada; 2Faculty of Medecine, McGill University, Montreal, QC, Canada; 3Department of Robotic Surgery, Hôpital Sacré Coeur de Montréal, Montreal, QC, Canada
Introduction: Active surveillance (AS) is a widely accepted management option for prostate cancer (PCa) patients with low-risk and for selected cases of intermediate-risk disease . However, it is estimated that around 30% of these patients tend to progress during their follow-up of which around 50% experience biochemical recurrence after definitive treatment. The aim of this study was to describe the oncological and pathological outcomes in patients undergoing deferred Robotic assisted radical prostatectomy (RARP) after AS.
Methods: We conducted a retrospective chart review on a RARP database of 1737 patients who underwent RARP for localized prostate cancer between 2007 and 2019,and identified patients under AS before RARP (Table1). Final pathology with adverse findings including: pT3 or more, ISUP grade 3 or more, positive surgical margin (PSM), and positive lymph node were collected. Other outcomes included are overall survival (OS), cancer-specific survival (CSS), and biochemical recurrence (BCR).
Results: Two hundred and eight patients with a mean age of 61.4 (SD= 6.1) years were included. D’Amico risk stratification was as following: low (41%), intermediate (72%), and high (7%). The median time spent in active surveillance was 24.6 months (range: 2.9 – 173.8). The total PT3 disease, ISUP grade 3 and greater, PSM, were 38.6%, 17.2%, and 25.2%, respectively. Thirty patients underwent lymph node dissection of which 3 were found positive (1.5%). The median follow-up time after RARP was 24.7 months (IQR: 9 – 53.3). The OS was 99.5% and CSS was 100%. Only 7% of the cohort had BCR and the mean time for a detectable PSA was 41.2 months (SD =20.3)(Table2).
Conclusions: When comparing our results with similar cohorts, the short-term pathological and oncological outcomes of men previously managed with AS do not seem to be adversely affected when treated with RARP.