Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

Abstract

Abbreviations & AcronymsObjectives: Urologists are cautious to offer minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen (and therefore anticipated to have locally advanced or metastatic disease) because of concerns regarding lack of complete cure after minimally invasive radical prostatectomy and of worsening of continence if adjuvant radiotherapy is used. Methods: A retrospective review of our institutional database was carried out to identify patients with PSA Ն20 ng/mL who underwent minimally invasive radical prostatectomy between January 2002 and October 2010. Intraoperative, pathological, functional and short-term oncological outcomes were assessed. Results: Overall, 233 patients met study criteria and were included in the analysis. The median prostate-specific antigen and prostate size were 28.5 ng/mL and 47 mL, respectively. Intraoperative complications were the following: rectal injury (0.86%) and blood transfusion (1.7%). Early postoperative complications included prolonged (>6 days) catheterization (9.4%), hematoma (4.7%), deep venous thrombosis (0.86%) and lymphocele (5.1%). Late postoperative complications included cerebrovascular accident (0.4%) and anastomotic stricture (0.8%). Pathology revealed poorly differentiated cancer in 48.9%, pT3/pT4 disease in 55.8%, positive margins in 28.3% and lymph node disease in 20.2% of the cases. Adverse pathological findings were more frequent in patients with prostatespecific antigen >40 ng/mL and (or) in those with locally advanced disease (pT3/pT4). In 62.2% of the cases, adjuvant radiotherapy was used. At 1-year follow up, 80% of patients did not show evidence of biochemical recurrence and 98.8% of them had good recovery of continence. Conclusion: Minimally invasive radical prostatectomy might represent a reasonable option in prostate cancer patients with high prostate-specific antigen as a part of a multimodality treatment approach.

Editorial Comment to Denonvilliers' space expansion by transperineal injection of hydrogel: Implications for focal therapy of prostate cancer

“…4 During the past decade, a shift has occurred from an open surgical approach toward minimally-invasive techniques, such as laparoscopic radical prostatectomy (LRP), robot-assisted laparoscopic radical prostatectomy, cryotherapy and high-intensity focused ultrasound. 5,6 The incidence of rectal injury during cryosurgery compares favorably with that in published series of open retropubic radical prostatectomy, LRP and robot-assisted laparoscopic radical prostatectomy. Standard LRP show a rectal injury rate as high as 8% in small single series, and a 0.7-2.0% incidence in high-volume center series.…”

Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis

“…The remaining 60 (68%) were retrospective noncomparative level 4 studies. Study characteristics are detailed in Table 1 [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , …”

Editorial Comment to Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

“…In this study, 3 the authors report on the outcome of patients that underwent laparoscopic radical prostatectomy for prostate cancer associated with high prostate‐specific antigen values. Of note, although the majority of patients with clinical T3 disease, in this series, had pT3/pT4 disease, 44.2% of patients had pT2 disease on final histology; offering these patients the possibility of better long‐term cancer control.…”