Robotic-assisted radical prostatectomy in men ≤50 years of age. Surgical, oncological and functional outcomes.

摘要

BACKGROUND: The aim of this study was to evaluate the surgical, oncological and functional outcomes in men ≤50 years of age treated with robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 68 patients who were ≤50 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status, continence and potency 12 months after treatment and presence of biochemical progression and disease-specific mortality during the follow-up period. RESULTS: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≤50 years of age. A statistical difference of the analyzed parameters was observed in prostate weight 56.1 g vs. 31.4 g (p<0.05), in bilateral neurovascular bundle (NVB) preservation 65.7% vs. 92.6% (p<0.05), and in oncological and functional outcomes. Organ-confined disease was noted in 73.5% vs. 78.5% (p<0.05), extraprostatic extension in 25.2% vs. 21.5% (p<0.05) and positive surgical margins were encountered in 8.9% vs. 5.8% (p<0.05). A Gleason score <7 was noted in 42.8% vs. 54.4% (p<0.05), a Gleason score 7 in 47.7% vs. 41.2% (p<0.05) and a Gleason score >7 in 9.5% vs. 4.4% (p<0.05). At 12 months, 92.8% vs. 95.5% were continent and 66.2% vs. 93.7% (p<0.001) were potent. After a median follow-up of 17.8 months, 97.1% patients of the ≤50 years patient cohort were free of biochemical progression and no disease-specific mortality was evident. CONCLUSION: Our findings suggest that RARP in patients ≤50 years of age is a safe surgical procedure with limited complications and excellent oncologial and functional outcomes. Although the preservation of the NVB in such patients is preferable, this can be performed without compromising the radical nature of cancer surgery.