Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

Abstract

Objectives:To investigate intraoperative and early postoperative complications of antegrade radical prostatectomy with intended wide resection (aRP) for clinically locally advanced prostate cancer (cLAD) and to compare with those of aRP for clinically localized prostate cancer (cLD). Methods: Between March 1994 and June 2007, 800 consecutive Japanese patients including 625 with cLD and 175 with cLAD underwent aRP and bilateral limited lymphadenectomy. Clinicopathological data including intraoperative and early postoperative complications (within 30 days after operation) were compared between cLD and cLAD groups. Results: No deaths occurred. Operative time and blood loss did not differ significantly between the groups. Intraoperative and early postoperative complications were observed in 11 (1.4%) and 123 (15.4%) of the entire cohort, respectively. Prevalent early postoperative complications were pelvic hematoma, wound infection, urinary retention and lymphocele or prolonged lymph drainage. There were no significant differences in the entire intraoperative and early postoperative complications between the groups. The majority of the early postoperative complications were minor. Conclusions: aRP for cLAD is technically feasible and a safe surgical procedure. If radical prostatectomy could be established as a standard treatment for cLAD in the future, aRP might be valuable as the first step of multimodal treatments.

Predictive ability of prebiopsy magnetic resonance imaging and biopsy for side‐specific negative lymph node metastasis at radical prostatectomy

“…Skilled surgeons performed RP and ePLND using either an open approach, minimal‐incision endoscopy, or robotic assistance. At our institution, limited lymph node dissection (LND) was the standard practice until 2012, when it was changed to ePLND 12,13 . In recent years, our institution has used the updated Briganti nomogram, and RP with ePLND was employed when the calculated probability of LNM exceeded 7% 14 …”

“…At our institution, limited lymph node dissection (LND) was the standard practice until 2012, when it was changed to ePLND. 12,13 In recent years, our institution has used the updated Briganti nomogram, and RP with ePLND was employed when the calculated probability of LNM exceeded 7%. 14 The data collected included patient age at surgery, initial prostate-specific antigen (PSA) level, biopsy Gleason score (GS), number of biopsy cores taken, digital rectal examination (DRE) findings, MRI findings, and final RP pathology including pathological T and N stage.…”

External validation of the Briganti 2019 nomogram to identify candidates for extended pelvic lymph node dissection among patients with high-risk clinically localized prostate cancer

“…Imaging studies preoperatively confirmed that all patients had no metastases. Skilled surgeons performed RP and ePLND (including external, internal iliac, and obturator lymph nodes) using either an open or minimum incision endoscopic or robot-assisted approach [ 14 , 15 ]. The probability of LNI was evaluated using the Briganti 2019 nomogram [ 7 ], Briganti 2017 nomogram [ 16 ], Briganti 2012 nomogram [ 17 ], MSKCC nomogram [ 18 ], Partin 2017 nomogram [ 19 ], and Japan PC table [ 20 ], based on clinical data and biopsy results (Table 1 ).…”

Editorial Comment to Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: A comparative study with clinically localized disease

“…The authors performed antegrade radical prostatectomy with wide resection of neurovascular bundles, bladder neck, and complete resection of Denonvilliers' fascia for patients with clinically locally advanced prostate cancer. These procedures are often associated with tedious bleeding from perirectal adipose tissue; however, the authors obtained satisfying surgical results and described their feasibility and safety in the study 1 …”