Outcomes of precision prostatectomy procedure for localized prostate cancer, and stepby-step technique of single port transvesical precision prostatectomy

Document Type

Conference Proceeding

Publication Date

2-1-2023

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Whole-gland treatment via radical prostatectomy or radiation is the mainstay of treatment for high-volume, low risk patients with prostate cancer (PCa), however it is associated with urinary and sexual side effects. Precision prostatectomy is a surgical technique that involves removal of >90% of prostatic tissue, while also preserving functional recovery. The single port da Vinci robotic platform allows for a transvesical approach to the prostate gland. We describe a case of single port transvesical precision prostatectomy and report outcomes of patients who have received multiport precision prostatectomy at our institution.

Materials & Methods: A 72-year-old patient with prior appendectomy and umbilical and hernia repair on active surveillance for unilateral left Grade Group 2 PCa elected to undergo surgery due to rising PSA. The following surgical steps are described: (1) transvesical access and robot docking, (2) anterograde bladder neck dissection, (3) standard dissection and nerve sparing on radical side, (4) development of precision plane, (5) apical dissection, (6) urethral transection, (7) posterior reconstruction, and (8) urethrovesical anastomosis. Oncological and functional outcomes of 88 patients with localized PCa undergoing multiport precision prostatectomy are reported.

Results: The patient underwent an uncomplicated single port transvesical precision prostatectomy. He was discharged on post op day (POD) 1 and passed trial of void on POD 8. He was fully continent by 4 weeks post foley removal. The patient has not yet tried sexual activity postoperatively due to life events. 11-month follow-up shows a stable PSA of 0.7. All 88 patients undergoing multiport precision prostatectomy were alive and metastasis free at a median follow up of 25 months. At 36 months, 82 (93)% of patients were free from clinically significant residual PCa, 80 (91)% had not undergone additional treatment, and 100% were alive and free of metastatic disease. Two patients had biochemical failure according to Phoenix criteria, and 25 (22%) using the more stringent AUA post-RP criterion. However, detectable PSA was due to prostate cancer in only 10 patients as detected on biopsy of the remnant. Six (5%) patients underwent removal of the remnant; all six were free from biochemical failure after remnant removal at median follow-up of 10.2 months. At 12 months, 80 (91)% of patients were pad free, and 79 (90)% of the preoperatively potent patients had a SHIM score of 17 or more.

Conclusions: Precision prostatectomy offers excellent postoperative functional results while minimizing PCa undertreatment. Single port transvesical precision prostatectomy is feasible and safe in select patients. Close patient follow-up and investigation into long-term oncological outcomes are necessary.

Volume

83

First Page

S1933

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