10-year follow-up and outcomes following LRP

Touijer et al. have published the first 10-year follow-up and outcome data on patients treated using (non-robot-assisted) laparoscopic radical prostatectomy (LRP). These patients were all treated by one or other of two surgeons at either L’Institut Mutualiste Montsouris (IMM) in Paris, France, or Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, USA.

Progression of disease was defined by a PSA level of ≥ 0.1 ng/ml, with a confirmatory rise or initiation of secondary therapy. Patients were stratified as low, intermediate, or high risk based on pretreatment prostate cancer nomogram progression-free probabilities of >90, 89-71, and <70 percent, respectively.

The results of this study are as follows:

  • The two surgeons treated 1,564 consecutive patients between 1998 and 2007
  • All patients had clinically localized disease (stages cT1c-cT3a).
  • The overall 5-year probability of freedom from progression (PFP) was 78 percent.
  • The overall 8-year probability of freedom from progression was 71 percent.
  • The 5-year PFP for low-risk patients was 91 percent, for intermediate-risk patients 77 percent, and for high-risk patients 53 percent.
  • Surgical margins (SMs) were positive in 13 percent of the cases.
  • Nodal metastases were detected in 3 percent of the patients after limited pelvic lymph node dissection (PLND) and in 10 percent of patients after a standard PLND.
  • The 3-year PFP for node-positive patients was 49 percent.
  • There were 22 overall deaths and just 2 deaths from prostate cancer.

The authors conclude that (a) LRP provided 5- and 8-year cancer control in 78 and 71 percent of patients with clinically localized prostate cancer and in 53 percent of those with high-risk cancer at 5 years and that (b) a PLND limited to the external iliac nodal group is inadequate for detecting nodal metastases.

It is obviously not possible to make absolute comparisons to data from other 10-year series of surgical and radiotherapy patients, but it is worth noting that the overall, actuarial 5-year and 10-year recurrence-free survival rates of 2,404 patients treated by Walsh at Johns Hopkins were 84 and 74 percent, respectively (see Han et al.). Clearly LRP is “in the same ballpark” when carried out by highly experienced surgeons.

2 Responses

  1. It is important that men chose surgeons who are experienced and have a good success rate as you said above.

    Quote from Medical News Today,”Data at our institution as well as a recently published article in the Journal of Clinical Oncology have shown inferior outcomes for laparoscopic prostatectomy”. http://www.medicalnewstoday.com/articles/131217.php

    This highlights the need for additional research. As with every treatment that is “new”, men need to be sure to research it and the physician performing it well prior to choosing it as an option.

  2. Kathy: The article you reference sadly gives no source data for the conclusion that they state about LRP/RALP at the Mayo Clinic (which is “their institution”), and their conclusion does not correlate to the 10-year data LRP data above. I think what we are seeing here is the usual “sniping” between specialties (and subspecialties).

    Furthermore, the JCO article that the authors refer to (by Hu et al.) is a retrospective analysis of Medicare data collected between 2003 and 2005. Most urologists had barely started doing LRP/RALP in that time frame. They certainly hadn’t gained significant experience. I do wish people wouldn’t make such misleading generalizations.

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