Outcome of laparoscopic radical prostatectomy in high-risk prostate cancer

Purpose: Because of the lack of conclusive and well-conducted randomized studies, the optimal therapy for high-risk prostate cancer remains controversial. We investigated the results of patients with high-risk prostate cancer after laparoscopic radical prostatectomy (LRP). Materials and Methods: The records of 75 prostate cancer patients undergoing LRP between 2001 and 2008 with preoperative high-risk prostate cancer were reviewed. Patients who underwent radiation therapy for prostate cancer before LRP and patients with lymph node or distant metastases were excluded. High-risk prostate cancer was defined as a prostate-specific antigen (PSA) level of more than 20 ng/ml, a biopsy Gleason score of greater than 7, or a clinical stage greater than T2c. Biochemical recurrence (BCR)-free survival was plotted via the Kaplan-Meier method. Results: After a mean follow-up of 36.1 months, 24 (32%) patients experienced PSA progression with a median time of 17.6 months. Twenty patients received adjuvant hormonal or external beam radiation therapy or both before BCR. The BCR-free survival calculated by the Kaplan-Meier method at 3 and 5 years was 47.4% and 33.8%, respectively. A total of 44.0% of the patients had stage pT2 disease and 56.0% had stage pT3 disease. Surgical margins were positive in 35 patients (46.7%), of whom 11 (31.4%) had positive margins of more than 1. Preoperative PSA, postoperative pathologic Gleason score, and stage were correlated with BCR. Conclusions: Our results suggest that LRP is a useful tool in the management of high-risk prostate cancer because it provides adequate local control of the prostate and pathological stage. Selection of patients with high-risk prostate cancer who require surgical treatment should be evaluated further in more studies.