Contemporary Laparoscopic and Open Radical Retropubic Prostatectomy: Pathologic Outcomes and Kattan Postoperative Nomograms Are Equivalent

Objectives: Although contemporary cohort comparisons are lacking, open surgeons have questioned the oncologic efficacy of laparoscopic radical prostatectomy (LRP) owing to the lack of haptic feedback. As such, we compared the pathologic outcomes and predicted the progression-free survival after open radical prostatectomy (ORP) and LRP in a single referral setting within a defined period, thereby isolating the effect of the surgical technique alone. Methods: Data were collected on 169 ORPs and 111 LRPs performed at our institution from May 2003 to May 2005. The surgical pathologic outcomes were compared, and the Kattan postoperative nomogram was used to calculate the 5 and 7-year progression-free probabilities after ORP and LRP. Results: On univariate analysis, no differences were found in age, Gleason sum, stage, margin status, extracapsular extension, and seminal vesicle invasion. The positive margin rate was 29% for LRP and 35% for ORP (P = 0.29), and no difference was found even after stratifying by pathologic stage. After controlling for Gleason sum, extracapsular extension, seminal vesicle invasion, nodal involvement, margin status, and preoperative prostate-specific antigen, no difference was found in detectable prostate-specific antigen after ORP and LRP (P = 0.73). When the Kattan postoperative nomogram was used to compute the biochemical progression-free probabilities, no differences were found at 5 (P = 0.51) and 7 years (P = 0.50). Conclusions: In this contemporary series without the confounding effects of stage migration, regional practice variation, or the use of historical controls, the pathologic outcome after conventional LRP was similar to that after ORP. Biochemical progression-free survival was also similar using a validated multivariate predictive model.