Laparoscopic radical prostatectomy after neoadjuvant hormonal therapy: an apparently safe and effective procedure

In an effort to determine the safety and efficacy of laparoscopic radical prostatectomy (LRP) in patients who have received neoadjuvant hormonal therapy (NHT), our initial series of 65 patients undergoing successful LRP was analyzed, specifically comparing 5 patients who received neoadjuvant hormonal therapy to 60 who did not.

From March 2000 to March 2002, 68 patients were scheduled for LRP. Three cases, none post-NHT, were converted to open radical retropubic prostatectomy (RRP). Clinical and pathologic data were recorded on the remaining 65 patients, 5 of who had received NHT. Forty-two bilateral and 16 unilateral nerve sparing LRP were performed in the non-NHT cohort, and 3 bilateral and 1 unilateral nerve sparing LRP in the NHT cohort.

The mean patient age, preoperative prostate specific antigen (PSA), clinical stage, and biopsy grade were similar for the NHT and the non-NHT LRP cohorts. The mean estimated blood loss (EBL) and serum hemoglobin decrease (preoperative to postoperative day 1) were lower in the NHT cohort than the non-NHT cohort: 160 mL and 2.4 g/dL vs. 317 mL and 3.1 g/dL, respectively. The mean operative time and hospital stay were similar: 5.7 hours and 2.4 days for the NHT cohort and 5.8 hours and 2.8 days for the non-NHT cohorts. As expected, the mean prostate weight was lower for the NHT cohort: 36.8 g vs. 46.5 g. All NHT cohort tumors were pathologic stage pT2, with negative margins. Eleven (18%) of the non-NHT cohort had pathologic T3 (10 patients) or T4 (1 patient) tumors and 10 (17%) specimens had a positive surgical margin. Four of 5 (80%) NHT cohort and 21 of 25 (84%) non-NHT cohort patients are continent (no pad use) 3 to 6 months postsurgery. One NHT cohort patient (20%) and 20 (33%) non-NHT cohort patients had an elevated drain fluid creatinine 24 hours postoperatively. There were no other complications in the NHT cohort. All 5 NHT cohort patients have no evidence of recurrent disease, whereas 2 non-NHT cohort patients (3.3%) have developed PSA recurrence. No NHT patient and only 1 non-NHT patient received a blood transfusion postoperatively.

LRP appears to be a safe and efficacious procedure in patients who have received NHT. Perioperative morbidity of NHT patients undergoing LRP appears equivalent to non-NHT patients, with slightly lower EBL, hemoglobin decrease, urinary extravasation, positive margin, and complication rates.