Objectives:
To evaluate the pre-operative characteristics of prostate cancer (PCa) with confirmed seminal vesicle invasion on pathology (pT3b) after robot-assisted laparoscopic prostatectomy (RALP).
Methods:
As part of the prospective Be-RALP project, from October 2009 till March 2016, 848 patients with clinical or pathological seminal vesicle invasion were evaluated.
Results:
Of the 79 patients with clinical T3b disease, 56 (71%) had seminal vesicle invasion on pathologic evaluation of the RP specimen. Seven hundred ninety-six patients with pT3b PCa were operated with RALP, of which 546 (69%) received pelvic lymph node dissection (PLND). Median PSA was 10 (IQR 7-17) and 187 patients (24%) had clinical T3-4 disease (Table 1).
Table 1: Comparison of patient/tumor characteristics between the pT3b RALP group with and without PLND shows several significant differences.
(PSA: prostate specific antigen, cTNM: clinical tumor/node/metastasis)
Patient / tumor
|
total (n=796)
|
RALP+PLND (n=546)
|
RALP (n=250)
|
p value
|
age, yr
|
65 (60-70)
|
65 (60-69)
|
65 (61-69)
|
0.545
|
PSA, µg/l
|
10 (7-17)
|
12 (8-20)
|
8 (6-11)
|
<0.001
|
cT stage, n (%)
|
|
|
|
<0.001
|
T1-2
|
598 (76)
|
380 (71)
|
218 (88)
|
|
T3-4
|
187 (24)
|
158 (29)
|
29 (12)
|
|
cN positive, n (%)
|
29 (4.6)
|
28 (6.4)
|
1 (0.5)
|
<0.001
|
biopsy grade group, n (%)
|
|
|
|
<0.001
|
1
|
129 (17)
|
41 (7.7)
|
88 (36)
|
<0.001
|
2 - 3
|
361 (47)
|
247 (47)
|
114 (47)
|
0.976
|
4
|
152 (20)
|
125 (24)
|
27 (11)
|
<0.001
|
5
|
132 (17)
|
117 (22)
|
15 (6.1)
|
<0.001
|
biopsy details
|
|
|
|
|
cores, n (%)
|
11 (8-12)
|
11 (8-12)
|
10 (8-12)
|
0.089
|
positive cores, n (%)
|
6 (4-8)
|
6 (4-9)
|
4 (3-6)
|
<0.001
|
positive / total cores, %
|
57 (38-83)
|
63 (42-92)
|
50 (30-67)
|
<0.001
|
highest involvement, %
|
80 (50-100)
|
90 (57-100)
|
66 (22-90)
|
<0.001
|
Of the patients with grade group >3 on biopsy, 15% did not receive PLND, compared to 22% on pathology (p=0.019). PLND was performed in 8%(4/50) low-risk, 52%(114/219) intermediate-risk and 79% (259/329) high-risk localized PCa patients. Eighty-five%(169/198) of patients with high-risk locally advanced disease received PLND. After multivariate analysis (including risk group) year of surgery (p<0.001) and percentage positive / total biopsy cores (OR1.01[1.005-1.018], p=0.001) were significant predictors for receiving PLND.
Conclusions:
Clinical T3-4 disease was reported before RALP in only 24% of all pT3b PCa tumors. The use of PLND increased over time. Next to risk group, Belgian urologists also include percentage of positive biopsy cores in their decision making to perform PLND or not.