Assessment of oncological and functional outcomes of retropubic radical prostatectomy: An academic center experience

PURPOSE

To report perioperative, pathological, oncological and functional outcomes of a contemporary series of retropubic radical prostatectomy (RRP), performed by one experienced surgeon.

METHODS

We analyzed data from a prospectively gathered database of consecutive patients who were treated by an RRP as first-line treatment for localized prostate cancer, from January 2014 to December 2019, in a single French academic center.

RESULTS

Overall, 364 patients were included. Median age and PSA were 65.7 years and 8.0ng/mL. According to D'Amico risk classification, 13.7% patients had a low-risk prostate cancer, 41.5% a favorable intermediate-risk, 23.4% an unfavorable intermediate-risk and 21.4% a high-risk prostate cancer. The rates of pT2 and pT3 were 48.6% (n=177) and 51.4% (n=187), respectively. The rates of non-nerve sparing surgery (NSS), unilateral NSS and bilateral NSS were 19.5% (n=71), 32.7% (n=119) and 47.8% (n=174). Total positive surgical margin (PSM) rate was 12.6% (n=46). Total pT2 PSM and pT3 PSM rates were 0.6% (n=1) and 24.1% (n=45) and achieved a statistical difference (P<0.001). At a median follow-up of 1.9-year, biochemical recurrence (BCR) occurred in 47 (12,9%) patients. Extracapsular extension was associated with a poor BCR-free survival as compared to organ confined disease (P<0.0001). At 2.7 years of follow-up, urinary continence rate was 88% (322/364). After exclusion of non-NSS RRP and non-interpretable questionnaires (score 1-4), median IIEF-5 score was 16 (8-20).

CONCLUSION

Retropubic radical prostatectomy ensures optimal pathological and functional results, in a current predominantly population of intermediate-risk prostate cancer and high-risk prostate cancer.

LEVEL OF EVIDENCE

3.