Original articleMidterm outcomes of four-port extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer within Asian population

ObjectiveAsian patients tend to have higher stage prostate cancer at diagnosis compared with patients of other races. This article aims to investigate the use of four-port extraperitoneal laparoscopic radical prostatectomy (EPLRP) as the first step in a multimodality treatment strategy for Asian patients with high-risk prostate cancer (HRPC).Materials and methodsA cohort of 202 patients underwent EPLRP between January 2006 to January 2016, of whom 122 (60.3%) had HRPC as defined by D'Amico classification: clinical T stage ≥ cT2c or PSA level ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). All patients underwent proper preoperative staging. The median age was 68 years (48-82), PSA level 17.8 ng/mL (3.3-191.1), and biopsy Gleason sum 7 (6-10). All patients underwent pelvic lymphadenectomy, and some underwent neurovascular bundle preservation according to their risk category.ResultsPerioperative outcomes included a median operative time of 185 min (65-380), total blood loss 150 ml (30-500), postoperative hospitalization 10 days (6-25), and urethral catheterization time 7 days (4-22). No patient was converted to open surgery. Median specimen weight was 42 g (19-124), lymph node yield was 10 (0-35) with 11.5% positivity and a positive surgical resection margin rate of 28.7%. The median follow-up period was 37 months (6-129). 96.7% of patients achieved continence and 53.8% of the 39 potent patients prior to surgery maintained their sexual potency at one year after EPLRP. The 5-year cancer-specific, overall, and biochemical recurrence-free survival rates were 98.8%, 92.2%, and 68.7%, respectively.ConclusionExtraperitoneal laparoscopic radical prostatectomy has low morbidity, and can provide fair functional and oncological outcomes as the first step of a multimodality treatment strategy for high-risk prostate cancer in Asian.