Prophylactic Robotic-assisted Laparoscopic Radical Prostatectomy for Preoperative Suspicion of Prostate Cancer: Experience with 55 Cases: Beyond the Abstract

Prophylactic surgery is considered acceptable for pre-malignant lesions and high level of risk of developing cancer of the colon and breast, especially in patients with family history [1-3].

A subset of patients with suspicious prostate cancer raises concern about the possible presence of malignant disease, and those men also suffered lower urinary tract symptoms and anxiety of elevated prostate-specific antigen (PSA) [4-5]. We have been learned from our patients and patients’ families, including patients themselves are doctors that they encourage us to carry out prophylactic robotic-assisted laparoscopic radical prostatectomy (P-RARP) for them due to high suspicion of prostate cancer. We performed 1.3 case/month (55 case in 42 months) from Feb. 2012 to July 2015, currently 5.8 case/month (70 case in 13 months) from Aug. 2015 to Sep. 2016. Our publication on journal of anti-cancer research, it concluded prophylactic RARP with bilateral neurovascular bundle preservation is safe for patients with suspicion of prostate cancer when performed by experienced surgeons [4]. Postoperatively, P-RARP improves urinary function, quality of life and free of patient’s anxiety [4]. Moreover, at 12-month followup after P-RARP for sex function at 36 preoperative potent patients, we used the International Index of Erectile Function (IIEF) scale, preoperatively and postoperatively. Postoperatively, potency (i.e. an erection sufficient for intercourse) was achieved 88.9% (32/36) with (N=9) or without (N=27) phosphodiesterase type-5 (PDE5) inhibitors. 

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Written by: Yen-Chuan Ou MD, PhD

Department of Medical Research; Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan


References:
1. Ludwig KK, Neuner J, Butler A, Geurts JL, Kong AL.Risk reduction and survival benefit of prophylactic surgery in BRCA  mutation carriers, a systematic review. Am J Surg. 2016; S0002-9610(16):  30348-8. 

2. Kotsopoulos J, Huzarski T, Gronwald J, Singer CF, Moller P, Lynch HT, Armel S, Karlan B, Foulkes WD, Neuhausen SL, Senter L, Tung N, Weitzel   JN, Eisen A, Metcalfe K, Eng C, Pal T, Evans G, Sun P, Lubinski J, Narod SA; Hereditary Breast Cancer Clinical Study Group. Bilateral Oophorectomy and Breast Cancer Risk in BRCA1 and BRCA2  Mutation Carriers. J Natl Cancer Inst. 2016;109(1). 

3. Huang JL, Zheng ZH, Wei HB, Huang Y, Chen TF, Wei B. Laparoscopic total colectomy and proctocolectomy for the treatment of  familial adenomatous polyposis. Int J Clin Exp Med. 2015; 8(6):9173-6. 

4. Ou YC, Weng WC, Chang KS, Mei CE, Yang CK, Hung SW, Wang J, Tung MC. Prophylactic Robotic-assisted Laparoscopic Radical Prostatectomy for Preoperative Suspicion of Prostate Cancer: Experience with 55 Cases. Anticancer Res. 2016;36(9):4895-901.

5. Brindle LA, Oliver SE, Dedman D, Donovan JL, Neal DE, Hamdy FC, Lane JA and Peters TJ. Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK. BJU Int 2006; 98: 777-782. 
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