Focal ablative therapy may be a suboptimal option for anterior prostate cancers (APCs) reaching the prostate apex due to concerns for thermal injury to the external sphincter.
To explore the technical feasibility of anterior partial prostatectomy (APP) for isolated APCs detected by magnetic resonance imaging (MRI), and to report short-term oncologic and functional outcomes.
Following institutional review board approval, over an 8-yr period (2008-2015) 17 consenting patients were enrolled in a prospective single-arm single-center Innovation, Development, Exploration, Assessment, Long-term (IDEAL) phase 2a study. Inclusion criteria comprised preurethral, low- to intermediate-risk APC diagnosed by MRI, and targeted biopsies. Robotic template APP was performed; posterolateral aspect of the submontanal urethra, peripheral zone, and periprostatic tissues were preserved intact. Median follow-up was 30 mo (interquartile range [IQR]: 25-70).
We noted the incidence of perioperative complications and examined reports of pathology, prostate-specific antigen (PSA), imaging, biopsies, and questionnaires.
Preoperatively, median PSA was 9.8 ng/ml, Gleason score was 6-7 (3 + 4), and cancer volume was 3.7cm(3) (IQR: 1.7-4.6). The technique was feasible in all cases. Perioperative complications included anastomotic leak (12%; G2), urinary tract infection (6%; G2), and transient intestinal ileus in one case (6%; G2). At 3 mo, continence and potency rates were 100% and 83%, respectively. Median nadir PSA was 0.4 ng/ml (IQR: 0.3-0.7). All margins and posterolateral margins rates were 55% and 35%, respectively. APC recurrence-free survival at 2 yr was 0.86 (95% confidence interval [CI], 0.55-0.96). Four patients (24%) who recurred underwent an uncomplicated completion of robot-assisted prostatectomy. Regarding limitations, CIs are quite wide for reported outcomes.
Robotic partial prostatectomy for isolated APC is feasible with good functional results. While promising, much more research is needed to verify our initial outcomes and appropriately position APP in the treatment paradigms for APC.
We explored a novel approach for partial prostatic surgical ablation for prostate cancer located in the anterior part of the prostate as an alternative to other focal ablative techniques.
European urology. 2016 Sep 06 [Epub ahead of print]
Arnauld Villers, Philippe Puech, Vincent Flamand, Georges-Pascal Haber, Mihir M Desai, Sebastien Crouzet, Xavier Leroy, Sameer Chopra, Laurent Lemaitre, Adil Ouzzane, Inderbir S Gill
Department of Urology, CHU Lille, Université de Lille, Lille, France; Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France. Electronic address: ., Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France; Department of Radiology, CHU Lille, Université de Lille, Lille, France., Department of Urology, CHU Lille, Université de Lille, Lille, France., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA., Urology and Transplantation Department, Edouard Herriot Hospital, Université de Lyon, Lyon, France., Department of Pathology, CHU Lille, Université de Lille, Lille, France., Department of Urology, CHU Lille, Université de Lille, Lille, France; Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France.