Menon-precision prostatectomy (MPP): An idea, development, exploration, assessment, long-term follow-up (IDEAL)stage 1 study
Abdollah F, Jeong W, Dalela D, Palma-Zamora I, Sood A, and Menon M. Menon-precision prostatectomy (MPP): An idea, development, exploration, assessment, long-term follow-up (IDEAL)stage 1 study. Eur Urol Suppl 2019; 18(1):e622.
Eur Urol Suppl
Introduction & Objectives: Despite the encouraging increased utilization of active surveillance, a significant proportion of prostate cancer (PCa)patients don't qualify for this approach. In an attempt to mitigate the negative sequelae of radically treating PCa surgically, and diminish the harm of potential overtreatment, our senior investigator (MM)devised the novel MPP technique. In this IDEAL Phase 1 study, our objective was to describe the peri-operative morbidity and functional outcomes and in the first 8 patients who underwent this procedure between Jan 2017 and June 2017. Materials & Methods: Patients were offered MPP if they satisfied the following criteria on biopsy: 1)PSA £15 ng/ml, 2)stage £cT2, 3)dominant unilateral lesion with Gleason score £4+3 with any number of cores or % cores involved ipsilaterally on biopsy, and 4)no primary Gleason score 34 contralaterally with £3 cores involved contralaterally with no >50% involvement on biopsy; and 5)preoperatively potent without PDE5 inhibitors. This procedure entails complete surgical removal of one half of the prostate (i.e. the side with dominant nodule on biopsy)and removal of most of the other half; however, a thin rim of the prostate capsule on the non/less-affected side is maintained. Kaplan-Meier curves were used to estimate: 1)urinary continence recovery (use of 0 pad/day); 2)Sexual function recovery (erection sufficient for intercourse). Results: Median (interquartile range [IQR])age and PSA were 54 yrs (52-57)and 4 ng/ml (3.6-5.8)respectively. Pre-operatively, 50% of patients had Gleason 3+4 disease and were classified as NCCN intermediate-risk. Only 1 patient (12.5%)met Epstein's criteria for active surveillance. During surgery, intraoperative frozen sections from the remnant prostatic tissue were taken, and all resulted negative for malignancy. All patients had pT2 disease. Median (IQR)console time was 134 min (107.7-148.0). No complication was recorded after surgery. At 4-, 8-, and 12-months from surgery, 100%, 100%, and 100% recovered urinary continence (all patients recovered within 4 months), 87.5%, 87.5%, and 100% recovered sexual function, and median (IQR)PSA was 0.25 (<0.1-1.22), 0.14 (<0.1-0.92)and 0.20 (<0.1-0.4)ng/mL, respectively. Conclusions: Similar to the case of conservative surgical treatment in breast cancer, we propose a conservative surgical treatment for localized PCa, which showed excellent post-op functional outcomes recovery, and a very limited morbidity. While the initial PSA response seems satisfactory, a longer follow up is necessary to examine the oncological outcomes of the procedure.