The Role of Robot-assisted Radical Prostatectomy and Pelvic Lymph Node Dissection in the Management of High-risk Prostate Cancer: A Systematic Review

Yuh, Bertram; Artibani, Walter; Heidenreich, Axel; Kimm, Simon; Menon, Mani; Novara, Giacomo; Tewari, Ashutosh; Touijer, Karim; Wilson, Timothy G.; Zorn, Kevin C.; Eggener, Scott E.

doi:10.1016/j.eururo.2013.05.026

Cited by 140 publications

(106 citation statements)

References 48 publications

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“…However, the rate of multiple lymph node metastases has rarely been reported and ranges between 4 and 17% of cases [5]. Moreover, the rate of bilateral lymph node metastases is not reported in modern series [2,3,5,[15][16][17]. A large multicenter retrospective study including an old cohort has shown that in high-risk selected patients with at least 10 nodes removed (median 15), the rate of LNI was 36.1%, which included ROC, receiverreceiver operating characteristic; AUC, area under the curve; pN, pathologic nodal staging status; pN0, absence of nodal metastases; pN1(u), prostate cancer with unilateral metastatic nodes; pN1(b), prostate cancer with bilateral nodal metastases; PSA, prostate-specific antigen; P(p), proportion of biopsy positive cores.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Porcaro

Luyk²,

Corsi³

et al. 2017

Urol Int

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Background: In high-risk prostate cancer (HR-PCA), it is important to consider the factors associated with extensive lymph node invasion (LNI) before planning treatment methods. Objective: To investigate clinical predictors of bilateral LNI in HR-PCA. Materials and Methods: The study evaluated 261 consecutive patients who underwent radical prostatectomy with extended pelvic lymph node dissection. The multivariate multinomial logistic regression model was computed. Results: The high-risk category included 102 cases. Overall, LNI was detected in 28 patients (27.5%) and was bilateral in 11 cases (10.8%). Independent factors associated with LNI were prostate-specific antigen (PSA) and proportion of positive cores. The main model showed that only higher values of PSA increased the odds of bilateral LNI when compared to patients having unilateral LNI (OR 1.058; p = 0.018). The area under the curve of PSA predicting bilateral LNI was 0.819. Conclusions: In HR-PCA, the independent predictor of LNI was PSA, which varied among patients with bilateral and unilateral LNI.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Porcaro

Luyk²,

Corsi³

et al. 2017

Urol Int

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“…However, not all high-risk patients have a poor prognosis after RP. [5,6] Substantial number of RP specimens of the high-risk patients reveal downgrading in the final histopathological examination when compared to preoperative biopsy results. [7] In this study, we tried to evaluate the benefit of RP in the low-risk PCa patients suitable for AS and in the high-risk PCa patients who would be considered for alternative treatments such as RT and ADT instead of RP.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

Boylu¹,

Bindayı²,

Küçük³

et al. 2017

Turkish Journal of Urology

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Objective: To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. Material and methods:Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low-and high-risk PCa patients. Results:The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. Conclusion:Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results.

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“…3,4 It has been shown in multiple retrospective analysis that an adequate EPLND principally can be performed with the open, laparoscopic or robot-assisted technique. 5,6 However, it became evident that clinical reality varied extremely from guideline recommended practice in so far that most robotic surgeons either did not perform an EPLND although oncologically indicated or that the surgeons only performed some type of pick-up lymphadenectomy with less than 10 lymph nodes removed. 7,8 The manuscript published by Di Pierro and colleagues 9 is noteworthy since it clearly describes the learning curve in terms of lymph node yield and complications of an experienced surgeon with the open surgical technique.…”

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confidence: 99%

Extended pelvic lymphadenectomy in prostate cancer: Practice makes perfect

Heidenreich

Pfister

2015

CUAJ

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The Role of Robot-assisted Radical Prostatectomy and Pelvic Lymph Node Dissection in the Management of High-risk Prostate Cancer: A Systematic Review

Cited by 140 publications

References 48 publications

Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

Extended pelvic lymphadenectomy in prostate cancer: Practice makes perfect

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