Robotic Prostatectomy Has a Superior Outcome in Larger Prostates and PSA Density Is a Strong Predictor of Biochemical Recurrence

Abstract EN

Objectives.

The aims of this study were to compare the outcomes of robotic assisted laparoscopic prostatectomy (RALP) between patients who had larger (≥75 g) and smaller (<75 g) prostates and to evaluate the performance of PSA density (PSAD) in determining the oncological outcome of surgery.

Methods and Materials.

344 patients who underwent RALP at a single institution were included in the study.

Preoperative risk factors and postoperative, oncological outcomes, erectile function, and continence status were recorded prospectively.

Results.

During a mean follow-up of 20 months, biochemical recurrence PSA>0.2 was observed in 15 patients (4.3%).

Prostate size ≥75 g was associated with lower Gleason score on final pathology P=0.004 and lower pathological stage P=0.02 but an increased length of hospital stay P=0.05.

PSAD on binary logistic regression independently predicted biochemical recurrence (BCR) when defined as postoperative PSA >0.1 P=0.001 and PSA >0.2 P=0.039.

In both instances PSA was no longer a significant independent predictor.

Conclusions.

RALP in large prostates (≥75 g, <150 g) is as safe as RALP in smaller prostates and is associated with a lower pathological grade and stage.

Higher PSAD is independently associated with BCR and is superior to PSA as a predictor of BCR after RALP.