V473 TARGETED PARTIAL PROSTATECTOMY FOR ISOLATED, ANTERIOR CANCER: A NOVEL LAPAROSCOPIC/ROBOTIC TECHNIQUE

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You have accessJournal of UrologyProstate Oncology1 Apr 2010V473 TARGETED PARTIAL PROSTATECTOMY FOR ISOLATED, ANTERIOR CANCER: A NOVEL LAPAROSCOPIC/ROBOTIC TECHNIQUE Georges-Pascal Haber, Sebastien Crouzet, Philippe Puech, Laurent Lemaitre, Xavier Leroy, Jean-Francois Biset, Mihir M. Desai, Inderbir S. Gill, and Arnauld Villers Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Sebastien CrouzetSebastien Crouzet Lyon, France More articles by this author , Philippe PuechPhilippe Puech Lille, France More articles by this author , Laurent LemaitreLaurent Lemaitre Lille, France More articles by this author , Xavier LeroyXavier Leroy Lille, France More articles by this author , Jean-Francois BisetJean-Francois Biset Noumea, France More articles by this author , Mihir M. DesaiMihir M. Desai Los Angeles, CA More articles by this author , Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author , and Arnauld VillersArnauld Villers Lille, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Localized prostate cancer (PCa) located in the anterior fibromuscular stroma (AFMS) or transition zone (TZ) represents upto 25% of diagnosed PCa. Such PCa can be well-depicted by magnetic resonance imaging (MRI) and sampled by targeted needle biopsies. We hypothesized that if well-selected patients with isolated anterior PCa underwent partial prostatectomy, adequate oncologic control could accrue while eliminating the undesirable side effects of radical prostatectomy METHODS Over a 2-year period we identified 5 selected patients with an isolated, anterior, low-intermediate risk PCa who were potential candidates for targeted partial prostatectomy. IRB approval was obtained. The virgin, isolated PCa lesion was identified on multi-parametric MRI, and subsequently confirmed by targeted ultrasound-guided biopsies. Robotic or laparoscopic partial prostatectomy was performed for en-bloc template excision of AFMS, TZ, anterior horns of peripheral zone (PZ), bladder neck, and anterior aspect of prostatic urethra distal to verumontanum. Preserved intact were the rest of the prostate gland and the entire peri-prostatic neurovascular & musculo-fascial anatomy. Follow-up included PSA, MRI, prostate biopsy and QOL questionnaires RESULTS Mean age was 68.5 years, preoperative PSA was 14.3ng/ml (9.5-19.6) and Gleason score was 6 or 7 (3+4). Template anterior partial prostatectomy was technically feasible en-bloc in all 5 cases. There were no peri-operative complications and minimal morbidity. Positive margins occurred in 3 cases, focal anterior in 2 (therefore adjuvant therapy not offered), and residual PZ cancer in 1 (secondary radical prostatectomy with resultant undetectable PSA & normal continence). Of the other 4 cases, 2 maintained uninterrupted potency postoperatively. Continence remained uninterrupted in all patients. Mean PSA at 3 months and 1 y decreased to 0.49 ng/ml (0.28-0.64) and 0.40 ng/ml (0.25-0.53), respectively. One year follow-up multi-core needle biopsy showed no residual cancer in 2 patients, and a 1mm focus of new Gleason 6 PZ cancer in 1 patient. Mean follow-up was 11 months (3-15) CONCLUSIONS Targeted partial prostatectomy for isolated, anteriorly-located, low-intermediate risk PCa is feasible. Early clinical, histological, biological and MRI responses appear favorable, with moderate adverse effects. In these carefully selected patients, partial prostatectomy could represent an alternative to standard radical surgery. Further experience is necessary to determine the oncologic validity of this treatment concept © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e186-e187 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georges-Pascal Haber Cleveland, OH More articles by this author Sebastien Crouzet Lyon, France More articles by this author Philippe Puech Lille, France More articles by this author Laurent Lemaitre Lille, France More articles by this author Xavier Leroy Lille, France More articles by this author Jean-Francois Biset Noumea, France More articles by this author Mihir M. Desai Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Arnauld Villers Lille, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...