The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

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EFFECT OF DUTASTERIDE (5 ALPHA-REDUCTASE INHIBITOR) TREATMENT ON REDUCING BLOOD LOSS, IN PERIOPERATIVE PERIOD OF OPEN PROSTATECTOMY DONE IN LARGE PROSTATE.

10.36106/ijsr/5408179 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Prostate Volume ◽

Holmium Laser ◽

Transurethral Resection Of Prostate ◽

Open Prostatectomy ◽

Perioperative Bleeding ◽

Free Material ◽

Large Prostate ◽

Medical Colleges

Objective- Open prostatectomy (OP) is still a very valid option in treatment of very large volume prostates in the absence of holmium laser enucleation ( holmium laser is a rarity and expensive in govt and self funded medical colleges), its main complication being intra and perioperative bleeding. Preoperative use of dutasteride has shown to decrease perioperative bleeding in TURP (transurethral resection of prostate), though till date OP being a standard procedure in large prostate management ,there is no study showing effect of dutasteride in perioperative bleeding in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP could reduce blood loss in surgery, as high watt holmium laser is still not available in most of the medical colleges ,treating patients for free . Material and Methods- Data of 218 patients who underwent OP for BPH (benign prostatic hyperplasia), were investigated retrospectively. Of 218 patients ,46 were pretreated with dutasteride for 6 weeks and the rest were not under dutasteride treatment. Age, prostate volume , prostate specific antigen(PSA) levels, coagulation profile, platelet count, pre and post operative hemoglobin(Hb) levels ,and blood transfusion history were recorded .Blood loss was estimated as follows : pre operative Hb(-) post operative Hb(+) amount of blood transfusion. The 2 groups were compared by independent samples t-test and a p value of 0.05 was considered significant. Results- The groups were similar in terms of age , prostate volume ,platelet counts, coagulation tests and post operative Hb levels. Preoperative Hb levels were lower in dutasteride group (13.4 vs 14.3,p=0.002) and amount of bleeding (-2.72g/dl vs.-1.93g/dl, p=0.01) was shown to be significantly lower in dutasteride group. Conclusion -Our result showed that pretreatment with dutasteride for 6 weeks before OP for very large prostates, reduces perioperative bleeding , and can be used in medical colleges where treatment is free ,instead of using holmium laser, though further prospective randomized trials would support the effectiveness of such treatment.

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Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Frontiers in Oncology ◽

10.3389/fonc.2021.643051 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xueqing Cheng ◽

Jinshun Xu ◽

Yuntian Chen ◽

Zhenhua Liu ◽

Guangxi Sun ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Detection Rate ◽

Prostate Volume ◽

Targeted Biopsy ◽

Grade Group ◽

The Difference ◽

Large Prostate ◽

Systematic Biopsy ◽

Biopsy Method

PurposeTo determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration.Materials and MethodsPatients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume.ResultsA total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063).ConclusionThe combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.

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Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

Frontiers in Oncology ◽

10.3389/fonc.2021.714680 ◽

2021 ◽

Vol 11 ◽

Author(s):

Wen Deng ◽

Xiaoqiang Liu ◽

Weipeng Liu ◽

Cheng Zhang ◽

Xiaochen Zhou ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Prostate Volume ◽

Localized Prostate Cancer ◽

Oncologic Outcomes ◽

Robot Assisted ◽

Post Operation ◽

Grade Ii ◽

Large Prostate

ObjectiveWe aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up.Materials and MethodsPatients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups.ResultsAll operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively).ConclusionsFor surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.

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1029: Cancer to Total Prostate Volume Ratio Influences Patholgical Parameters and Biochemical Recurrence in Localized Prostate Cancer Treated by Radical Prostatectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)31257-6 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 340-340 ◽

Cited By ~ 1

Author(s):

Hong Gee Sim ◽

Donatello Telesca ◽

Stephen H. Culp ◽

Paul H. Lange ◽

William J. Ellis ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Prostate Volume ◽

Volume Ratio ◽

Localized Prostate Cancer

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Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

Journal of Robotic Surgery ◽

10.1007/s11701-021-01192-w ◽

2021 ◽

Author(s):

Antonio Benito Porcaro ◽

Alessandro Tafuri ◽

Riccardo Rizzetto ◽

Nelia Amigoni ◽

Marco Sebben ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Blood Loss ◽

Open Approach ◽

Intraoperative Blood Loss ◽

Tertiary Referral ◽

Robot Assisted ◽

The Third ◽

Major Complications

AbstractTo investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

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Single plus one port robotic radical prostatectomy (SPORP); Initial experience

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.3.178 ◽

2017 ◽

Vol 89 (3) ◽

pp. 178 ◽

Cited By ~ 4

Author(s):

Volkan Tugcu ◽

Abdulmuttalip Simsek ◽

Ismail Evren ◽

Kamil Gokhan Seker ◽

Ramazan Kocakaya ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Serum Level ◽

Blood Loss ◽

Clinical Stage ◽

Operating Time ◽

Positive Surgical Margin ◽

Robotic Radical Prostatectomy ◽

Postoperative Continence

Objective: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). Materials and methods: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. Results: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. Conclusions: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.

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Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.270 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 93 ◽

Cited By ~ 12

Author(s):

Stavros Sfoungaristos ◽

Petros Perimenis

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Prostate Volume ◽

Specific Antigen ◽

Secondary Analysis ◽

Intraepithelial Neoplasia ◽

Treatment Modalities ◽

Psa Density ◽

Group 2

Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy.Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2).Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively.Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned.

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Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality?

Medicina ◽

10.3390/medicina56060318 ◽

2020 ◽

Vol 56 (6) ◽

pp. 318

Author(s):

Giovanni Cochetti ◽

Diego Cocca ◽

Stefania Maddonni ◽

Alessio Paladini ◽

Elena Sarti ◽

...

Keyword(s):

Prostate Cancer ◽

Robotic Surgery ◽

Radical Prostatectomy ◽

Partial Nephrectomy ◽

Renal Carcinoma ◽

Robotic Prostatectomy ◽

Synchronous Tumors ◽

Renal Masses ◽

First Case ◽

Length Of Hospitalization

With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars’ positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.

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Bipolar Saline TURP for Large Prostate Glands

The Scientific World JOURNAL ◽

10.1100/tsw.2007.241 ◽

2007 ◽

Vol 7 ◽

pp. 1558-1562 ◽

Cited By ~ 16

Author(s):

David S. Finley ◽

Shawn Beck ◽

Richard J. Szabo

Keyword(s):

International Prostate Symptom Score ◽

Prostate Volume ◽

Length Of Hospital Stay ◽

Volume Measurement ◽

Open Prostatectomy ◽

Risk Patients ◽

Resected Tissue ◽

Feasible Alternative ◽

The Mean ◽

Large Prostate

The objective of this study was to evaluate the feasibility of bipolar transurethral resection of the prostate (TURP) in patients with very large prostate glands and significant comorbidities. Four patients with prostate glands >160 cc on preoperative volume measurement and ASA class three or higher underwent bipolar TURP with the Gyrus PlasmaKinetic system. Preoperative, operative, and postoperative parameters were studied. The results showed an average ASA class 3.25 (range: 3–4). The average preoperative prostate volume was 207.4 cc (range: 163–268). The average preoperative International Prostate Symptom Score (IPSS) and bother score was 31 and 6, respectively. Mean resection time was 163 min (range: 129–215). The weight of resected tissue and percentage of vaporized tissue was 80.8 g (range: 62–115) and 10.0% (range: 3.8–15.1), respectively. An average of 61L of saline was used (range: 48–78). The mean change in hemoglobin and serum sodium was 2.1 g/dl (range: 1.4–2.7) and 3.3 meq/l (range: 2–4), respectively. Postoperative catheter time averaged 76 h (range: 40–104). Mean length of hospital stay was 12 h (range: 4–24). The mean postoperative IPSS and bother score was 2.75 and 0.25, respectively. Bipolar TURP is a feasible alternative to simple open prostatectomy in high-risk patients with massive prostate adenomas. Prostate volume is reduced by approximately 10% due to vaporization.

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