Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy.

OBJECTIVES: To compare the prostate-specific antigen (PSA) recurrence (PSAR) rates in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Data from 797 consecutive patients who had RALP or RRP between August 2003 and January 2007 were retrieved from our database. Age, race, body mass index, PSA level, estimated blood loss (EBL), clinical and pathological stage, biopsy and pathological Gleason score, lymph node involvement, positive surgical margin (PSM) status, and prostate weight were compared between the groups. Multivariate analysis (logistic and Cox regression) was used to adjust for differences in clinical and pathological features when comparing the risk for PSM and PSAR.
RESULTS: In all, 362 men had RALP and 435 had RRP; the mean follow-up was 1.09 and 1.37 years, respectively. RALP patients had a significantly lower clinical stage, Gleason score and EBL (P < 0.001). There was no significant difference in PSM between RALP and RRP in univariate (P = 0.701) and multivariate analyses (P = 0.095). The risk of PSAR for patients undergoing RALP or RRP was not significantly different after adjusting for clinical (hazard ratio 0.82, 95% confidence interval 0.48-1.38; P = 0.448) and pathological differences (0.94, 0.55-1.61; P = 0.824).
CONCLUSIONS: Patients undergoing RALP had a lower EBL and lower-risk disease. After adjusting for differences in clinical and pathological features, there was no significant difference in early PSAR between patients undergoing RALP or RRP.