Apollo Gleneagles Hospitals, Kolkata

ROBOT ASSISTED RADICAL PROSTATECTOMY IN HIGH RISK PROSTATE CANCER

Prostate cancer is the most common non skin malignancy and associated with significant cancer associated mortality in male population. 15% - 30% of patients diagnosed with prostate cancer have high risk, non-metastatic disease. HRPC was classified as having any of the following features: PSA>20ng/ml, Gleason score 8 – 10, or clinical T stage ≥T2c. Patient should be treated in multimodality setting. RP is an option for treatment of HRPC either alone or as a part of multimodal therapy

Our database of RARP patients from January 2014 to December 2017. All the patients were operated by the same team comprising with single console surgeon and two surgeons at patient site for changing of hand instrument and assistance, using a da Vinci-S four arm surgical robot. All surgeries were performed through standard six port trans peritoneal approach.

All patients had preoperative data including clinical stage, PSA at diagnosis, needle biopsy Gleason Score. Patients were again reclassified according to final histopathology reports. Post-operatively all patients were followed up with PSA measurement at 3months and then every 3 monthly. Biochemical recurrence (BCR) was defined as two consecutive serum PSA value of > 0.2ng/ml. Functional outcome was evaluated only for incontinence..

Total no . 27 High risk - 20 Intermediate - 05 Low - 02 Pre-operative Post-operative High Risk - 24 Intermediate - 03 Low - 00

High risk group patients: Mean age of the patient were 64.77 years (range: 53years – 78years) Mean PSA level were 15.71 ng/ml (range: 7.24 – 37.5). Preoperatively,

Technique No. of patients Bilateral NVB sparing 16(59.3%) Unilateral NVB sparing 08(29.6%) Non-NVB sparing 03(11.1%)   Final HPE : 24(88.8%) patients had Gleason score 8-10 . 03 (11.2%) patients had Gleason score 7 . Only one (04.16%) patient had positive surgical margin. Two (8.33%) patients had EPE. Seminal Vesicle involvement was found in two (8.33%) patients.

No patients experienced cancer specific mortality. Median follow up of the patients was 24months (maximum 48 months). Biochemical recurrence was detected in 6 (25%) patients. Earliest BCR was at 3months. At 3months, 3(12.5%) patients developed BCR. Out of this 3patients one patient had margin positive disease. At 9 months another 3 patients developed BCR. At 2 years follow up BCR free survival rate were 75% in high risk group. Margin positivity and primary Gleason grade were two independent factors for BCR. Those patients with BCR received RT+ADT for management of BCR.

3 patients lost in follow up after 2 year. Rate of incontinence after operation: Urinary continence achieved after 1 year : 88.89% no. of patient No. of Pad Used Day 1 Day 7 Day 30 At 3 months At 6 months At 1 year Nil 00 07 10 20 22 24 01 05 08 04 02 02 – 03 16 06 > 03 03

Low risk group patients may turn to be high risk group in final HPE. RARP is an option in high risk group patients in multimodality setting. Low risk group patients may turn to be high risk group in final HPE. Margin positivity and primary Gleason grade were two independent factors for BCR. Continence usually improved with time and may take more than 1year time. Older group patient has also equivalent result like young patients.

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