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Proceedings Paper

Robot-assisted radical prostatectomy: histopathologic and biochemical recurrence data at one-year follow-up
Author(s): Vipul Patel; Rahul Thaly; Ketul Shah
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Paper Abstract

Introduction: Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short term PSA outcomes of 500 robotic prostatectomies. Materials and Methods: Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM Stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data was collected every three months for the first year, then every six months for a year, then yearly. Results: Average pre-operative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), 9(2%). Post operatively histopathologic analysis showed Gleason's 6 (44%), 7(42%), 8(10%), 9(4%). 10%, 5%, 63%, 15%, 5% and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b and T4 respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400) and 8% (401-500). By stage it was 2%, 4%, 2.5% for T2a, T2b, T2c tumors, 23% (T3a), 46% (T3b) and 53% (T4a). For organ confined disease (T2) the margin rate was 2.5% and 31% for non organ confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle and 11 (23%) multifocally. Ninety five percent of patients (n=500) have undetectable PSA (<0.1) at average follow up of 9.7 months. Recurrence has only been seen with non organ confined tumors. Those patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (<.1). Conclusion: Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall margin positive rate. Short term biochemical recurrence free survival has also been good. We believe that the precise dissection allowed by the advantages of laparoscopic robotic surgery will translate into excellent long term oncologic outcomes.

Paper Details

Date Published: 23 March 2007
PDF: 4 pages
Proc. SPIE 6424, Photonic Therapeutics and Diagnostics III, 642414 (23 March 2007); doi: 10.1117/12.701332
Show Author Affiliations
Vipul Patel, The Ohio State Univ. Medical Ctr. (United States)
Rahul Thaly, The Ohio State Univ. Medical Ctr. (United States)
Ketul Shah, The Ohio State Univ. Medical Ctr. (United States)

Published in SPIE Proceedings Vol. 6424:
Photonic Therapeutics and Diagnostics III
Henry Hirschberg M.D.; Brian Jet-Fei Wong M.D.; Reza S. Malek M.D.; Kenton W. Gregory M.D.; Nikiforos Kollias M.D.; Bernard Choi; Steen J. Madsen; Guillermo J. Tearney M.D.; Justus F. R. Ilgner M.D.; Haishan Zeng, Editor(s)

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