Radical Prostatectomy for Prostate Cancer after Ileal Pouch-Anal Anastomosis Offers Oncologic Control and Sustains Quality of Life

Abstract

We evaluated the feasibility and oncologic durability of performing prostate biopsy and open radical retropubic prostatectomy (RRP) in patients who have previously undergone proctocolectomy and ileal pouch-anal anastomosis (PC-IPAA). We performed a retrospective review of all patients at our institution who underwent an RRP after a PC-IPAA between June 1992 and February 2009. Variables evaluated included demographic characteristics, biopsy technique, tumor pathology, surgical technique, complications, and functional and oncologic outcomes. Sixteen patients were identified. Mean prostate-specific antigen was 9.3 ng/mL (median, 5.9 ng/mL; range, 4.3 to 26.8 ng/mL). Prostatic biopsy was performed without complication by a variety of radiographic techniques. Successful RRP was achieved in all patients without pouch violation or pouch-related postoperative complications. The most common intraoperative finding was pelvic adhesions between the posterior prostate/seminal vesicles and the IPAA. Neurovascular bundle preservation was not altered by pelvic adhesions in any patient in whom this was the goal of the operation. Urinary continence was restored by 3 months in 94% of patients and erectile function returned without the use of medication in 73% who had neurovascular bundle preservation. Overall pouch function was subjectively unchanged postoperatively. Biochemical recurrence occurred in 3 patients and local recurrence in 2 patients. Only 1 recurrence occurred within 5 years of RRP during a mean follow-up of 5.7 years (median, 3.8 years; range, 0.3 to 14.5 years). Despite altered pelvic anatomy from previous PC-IPAA, prostate biopsy and RRP can be done safely and effectively. Previous PC-IPAA should not be a contraindication to RRP in men with clinically localized prostate cancer.