Midterm outcomes of four-port extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer within Asian population

Objective: Asian patients tend to have higher stage prostate cancer at diagnosis compared with patients of other races. This article aims to investigate the use of four-port extraperitoneal laparoscopic radical prostatectomy (EPLRP) as the first step in a multimodality treatment strategy for Asian patients with high-risk prostate cancer (HRPC).Materials and methods: A cohort of 202 patients underwent EPLRP between January 2006 to January 2016, of whom 122 (60.3%) had HRPC as defined by D'Amico classification: clinical T stage ≥ cT2c or PSA level ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). All patients underwent proper preoperative staging. The median age was 68 years (48–82), PSA level 17.8 ng/mL (3.3–191.1), and biopsy Gleason sum 7 (6–10). All patients underwent pelvic lymphadenectomy, and some underwent neurovascular bundle preservation according to their risk category.Results: Perioperative outcomes included a median operative time of 185 min (65–380), total blood loss 150 ml (30–500), postoperative hospitalization 10 days (6–25), and urethral catheterization time 7 days (4–22). No patient was converted to open surgery. Median specimen weight was 42 g (19–124), lymph node yield was 10 (0–35) with 11.5% positivity and a positive surgical resection margin rate of 28.7%. The median follow-up period was 37 months (6–129). 96.7% of patients achieved continence and 53.8% of the 39 potent patients prior to surgery maintained their sexual potency at one year after EPLRP. The 5-year cancer-specific, overall, and biochemical recurrence-free survival rates were 98.8%, 92.2%, and 68.7%, respectively.Conclusion: Extraperitoneal laparoscopic radical prostatectomy has low morbidity, and can provide fair functional and oncological outcomes as the first step of a multimodality treatment strategy for high-risk prostate cancer in Asian