To describe a step-by-step guide for isolated MRI-detected anterior prostate cancer (APC).
Following IRB approval, over an 8-year period, (2008-2015) 17 consenting patients were enrolled in a prospective, single-arm, single-center, IDEAL phase 2a study. Inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to transperitoneal robot-assited radical prostatectomy procedure. Three steps of dissection were identified in this following order: 1-retrograde apical after dorsal venous plexus division, transition zone (TZ) enucleation and distal peripheral zone (PZ) sectioning. 2-antegrade at bladder neck (BN) after anterior BN sectioning, TZ enucleation upto verumontanum, and 3-lateral dissections including anterolateral PZ sectioning without incision of endopelvic fascias. We reported the incidence of perioperative complications. Robotic completion of prostatectomy in 4 cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 yr, respectively.
Robotic surgery comprised en-bloc excision of the anterior part of the prostate comprising of the AFMS, bladder neck, prostate adenoma (TZ and median lobe) along with proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra and anterior BN. Posterolateral parts of PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. Bladder opening was sutured to anterior sphincteric urethra wall and PZ lateral edges. Technique was feasible in all cases with no conversion to open procedure. Perioperative complications were only grade 2. Robotic completion of prostatectomy was feasible in the 4 cases with cancer recurrence.
Peripheral zone prostate sparing partial prostatectomy for isolated anterior cancer was feasible and safe and represents an option for highly-selected men with anterior cancers as an alternative to other focal ablative therapy. This article is protected by copyright. All rights reserved.
BJU international. 2017 Jan 23 [Epub ahead of print]
Arnauld Villers, Vincent Flamand, Rodriguez Arquimedes, Philippe Puech, Georges-Pascal Haber, Mihir M Desai, Sebastien Crouzet, Adil Ouzzane, Inderbir S Gill
Department of Urology,, CHU Lille, Université de Lille, F-59000, Lille, France., Clinica INDISA, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile., Department of Radiology, CHU Lille, Université de Lille, F-59000, Lille, France., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., USC Institute of Urology, Catherine & 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.