Abstract:Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason S… Show more
“…Radical prostatectomy is the treatment of choice for clinically localized PCa in patients with a life expectancy beyond 10 years ( 1 ). Despite the fact that PCa screening based on PSA has been associated with a decrease in PCa-related mortality, overdiagnosis, and overtreatment of silent PCa, 20%–30% of patients were diagnosed with high-risk localized and locally advanced PCa ( 1 , 19 ). According to Gandaglia et al, RARP provides a well-standardized, safe, and oncologically successful treatment choice in highly selected patients with locally advanced PCa ( 20 ).…”
IntroductionThe role of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa) has been debated over the years, but it appears safe and effective in selected patients. While the outcomes of transperitoneal RARP for high-risk PCa have been already widely investigated, data on the extraperitoneal approach are scarcely available. The primary aim of this study is to evaluate intra- and postoperative complications in a series of patients with high-risk PCa treated by extraperitoneal RARP (eRARP) and pelvic lymph node dissection. The secondary aim is to report oncological and functional outcomes.MethodsData of patients who underwent eRARP for high-risk PCa were prospectively collected from January 2013 to September 2021. Intraoperative and postoperative complications were recorded, as also perioperative, functional, and oncological outcomes. Intraoperative and postoperative complications were classified by employing Intraoperative Adverse Incident Classification by the European Association of Urology and the Clavien–Dindo classification, respectively. Univariate and multivariate analyses were performed to evaluate a potential association between clinical and pathological features and the risk of complications.ResultsA total of 108 patients were included. The mean operative time and estimated blood loss were 183.5 ± 44 min and 115.2 ± 72.4 mL, respectively. Only two intraoperative complications were recorded, both grade 3. Early complications were recorded in 15 patients, of which 14 were of minor grade, and 1 was grade IIIa. Late complications were diagnosed in four patients, all of grade III. Body mass index (BMI) > 30 kg/m2, Prostate-Specific Antigen (PSA) > 20 ng/mL, PSA density >0.15 ng/mL2, and pN1 significantly correlated with a higher rate of overall postoperative complications. Moreover, BMI >30 kg/m2, PSA >20 ng/mL, and pN1 significantly correlated with a higher rate of early complications, while PSA >20 ng/mL, prostate volume <30 mL, and pT3 were significantly associated with a higher risk of late complications. In multivariate regression analysis, PSA >20 ng/mL significantly correlated with overall postoperative complications, while PSA > 20 and pN1 correlated with early complications. Urinary continence and sexual potency were restored in 49.1%, 66.7%, and 79.6% of patients and in 19.1%, 29.9%, and 36.2% of patients at 3, 6, and 12 months, respectively.ConclusionseRARP with pelvic lymph node dissection in patients with high-risk PCa is a feasible and safe technique, resulting in only a few intra- and postoperative complications, mostly of low grade.
“…Radical prostatectomy is the treatment of choice for clinically localized PCa in patients with a life expectancy beyond 10 years ( 1 ). Despite the fact that PCa screening based on PSA has been associated with a decrease in PCa-related mortality, overdiagnosis, and overtreatment of silent PCa, 20%–30% of patients were diagnosed with high-risk localized and locally advanced PCa ( 1 , 19 ). According to Gandaglia et al, RARP provides a well-standardized, safe, and oncologically successful treatment choice in highly selected patients with locally advanced PCa ( 20 ).…”
IntroductionThe role of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa) has been debated over the years, but it appears safe and effective in selected patients. While the outcomes of transperitoneal RARP for high-risk PCa have been already widely investigated, data on the extraperitoneal approach are scarcely available. The primary aim of this study is to evaluate intra- and postoperative complications in a series of patients with high-risk PCa treated by extraperitoneal RARP (eRARP) and pelvic lymph node dissection. The secondary aim is to report oncological and functional outcomes.MethodsData of patients who underwent eRARP for high-risk PCa were prospectively collected from January 2013 to September 2021. Intraoperative and postoperative complications were recorded, as also perioperative, functional, and oncological outcomes. Intraoperative and postoperative complications were classified by employing Intraoperative Adverse Incident Classification by the European Association of Urology and the Clavien–Dindo classification, respectively. Univariate and multivariate analyses were performed to evaluate a potential association between clinical and pathological features and the risk of complications.ResultsA total of 108 patients were included. The mean operative time and estimated blood loss were 183.5 ± 44 min and 115.2 ± 72.4 mL, respectively. Only two intraoperative complications were recorded, both grade 3. Early complications were recorded in 15 patients, of which 14 were of minor grade, and 1 was grade IIIa. Late complications were diagnosed in four patients, all of grade III. Body mass index (BMI) > 30 kg/m2, Prostate-Specific Antigen (PSA) > 20 ng/mL, PSA density >0.15 ng/mL2, and pN1 significantly correlated with a higher rate of overall postoperative complications. Moreover, BMI >30 kg/m2, PSA >20 ng/mL, and pN1 significantly correlated with a higher rate of early complications, while PSA >20 ng/mL, prostate volume <30 mL, and pT3 were significantly associated with a higher risk of late complications. In multivariate regression analysis, PSA >20 ng/mL significantly correlated with overall postoperative complications, while PSA > 20 and pN1 correlated with early complications. Urinary continence and sexual potency were restored in 49.1%, 66.7%, and 79.6% of patients and in 19.1%, 29.9%, and 36.2% of patients at 3, 6, and 12 months, respectively.ConclusionseRARP with pelvic lymph node dissection in patients with high-risk PCa is a feasible and safe technique, resulting in only a few intra- and postoperative complications, mostly of low grade.
“…Two surgeons found L-RALP has the following advantages when they performed L-RALP: (1) It does not require the liberation of the bladder and the peri vesical space, and the operation is limited to the deep pelvic space around the prostate. The prostate could be completely resected within the fascia, and the integrity of the vascular and nerve bundles can be fully preserved, which could reduce the damage of radical prostatectomy as much as possible; (2) Intraoperative bleeding is reduced by suture ligation, avoiding the influence of thermal injury on long-term sexual function and urinary continence function; (3) The integrity of the puboprostatic ligament and pudendal artery is preserved; (4) A longitudinal incision is used to open the bladder to more easily expose the vas deferens and seminal vesicles, the separation steps of the bladder neck are reduced, and the damage to the detrusor muscle group is minimized; (5) The bladder neck is easy to identify and retain during the operation, which reduces the incidence of bladder neck contracture and ureteral orifice injury, shortening the indwelling time of the postoperative catheter [ 18 , 32 , 33 ]; (6) The anatomy of the L-RALP starts from the 6 o’clock position of the prostate because the Denonvillier fascia was thicker here, and it is easy to separate with scissors, which can completely preserve the outer fascia and NVB on both sides of the prostate; (7) A sub umbilical incision and 0° mirror can be used for the whole operation. At an extreme angle, a 30° mirror can be considered, or the observation hole mechanical arm raised to improve the field of vision.…”
Section: Discussionmentioning
confidence: 99%
“…The anterior bladder tissue closed and was anatomically reduced. The F18 double-cavity catheter was replaced, a pelvic drainage tube was placed, and specimens were collected [ 18 ]. Fig.…”
Background
Transversal approach for robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision (L-RALP) is a novel surgical method for patients with respectable prostate cancer.
Methods
There were 669 patients with prostate cancer underwent L-RALP or S-RALP which identified from April 2016 to April 2020. The perioperative outcomes, Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores, sexual function and urinary control ability were included and compared between two groups.
Results
In the 669 patients, 277 of them were included into the final analysis. 151 patients received S-RALP and 126 received L-RALP. Baseline features were balanced. Patients in the S-RALP group had significantly shorter average surgical time (135.93 vs 150.04 min; p < 0.001) than those in L-RALP group. Intraoperative bleeding volume, early postoperative complications rates, postoperative catheter removal time and hospital stays were comparable between two groups. There was no difference in biochemical recurrence at 3, 6, 12 and 18 months of follow-up. Of note, the urinary control function recovers of patients in the L-RALP group was significantly better than those in the S-RALP group. Moreover, patients in the L-RALP group had much better results of EPIC-CP (including urinary control and total score) than those in the S-RALP group at 6 week and 3, 6, 12 and 18 months.
Conclusions
Both S-RALP and L-RALP were safe and effective with similar long-term clinical outcomes in patients with respectable prostate cancer. Patients received L-RALP had significantly better postoperative outcomes including urinary control, and recovery period.
“…UI is a major concern after RP, specifically for low-and intermediate-low risk diseases, with incontinence rates reaching as high a 31% at 12 months even if nerve-sparing techniques are performed [20]. No single approach has demonstrated a clear superiority over others in terms of functional outcomes and quality of life [21]. Most patients may recover their continence after a long period, however, it stands to reason that a shorter time to recovery could be of great importance for preventing quality of life deterioration.…”
Urinary incontinence (UI) is a frequent complication of radical prostatectomy (RP), and identifying preoperative predictors may assist in patient selection and continence rehabilitation. We investigated the association between preoperative psychological factors and UI after RP. Consenting patients planned for RP were recruited prospectively to this pilot study. They responded to preoperative psychological surveys, including a depression anxiety stress scale, coping behavior questionnaire, general self-efficacy scale, revised life orientation test and locus of control scale (LCS). Incontinence severity was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and daily pad usage at 6 months after surgery. Correlation tests and linear regression models evaluated the association between psychological factors and UI. Twenty-five men with a median age of 69 years were enrolled. Continence outcomes at 6 months were a median ICIQ-SF score of 11 (Interquartile range (IQR) 7–14) and a median use of 2 pads per day (IQR 1–5). LCS was linearly correlated to ICIQ-SF scores (p = 0.05) and daily pad use (p = 0.005). Age and pathological staging were also linearly correlated to incontinence severity. LCS remained linearly associated with daily pad use on multivariate analysis adjusting for age and pathology (β = 0.61, p = 0.007). Locus of control is a psychological predictor for post-RP UI severity, and patients with external control may be prone to worse incontinence. The LCS may be used when counseling patients before surgery in order to clarify expectations regarding postoperative continence. Future studies to evaluate whether psychological intervention may be beneficial for continence rehabilitation are warranted.
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