The management of locally advanced high risk prostate cancer is challenging. The various guidelines have suggested radical prostatectomy, as one of the options , in a multimodality approach. We prospectively evaluated the feasibility, safety and efficacy of 3-D laparoscopic transperitoneal radical prostatectomy, as a multimodality approach, in locally advanced high risk prostate cancer.
All consecutive patients undergoing 3-D laparoscopic transperitoneal radical prostatectomy in locally advanced high risk prostate cancer, as a multimodality approach, by a single surgeon, between June 2012 and May 2017, at our institution were included. The various clinical data were recorded and analyzed. We are presenting video of one such case.
Out of total 101 patients operated during this period, 31 patients were locally advanced and high risk. The mean age was 61.3 years with mean serum PSA of 21.1. The mean operating time and mean estimated blood loss were 195.3 min and 197.1 ml respectively. There was no open coversion. The intraoperative complications were seen in only 2 (6.4% ) patients, as Clavien 1–2. The mean catheterization time was 9.7 days. The postoperative complications were seen as Clavien 1–2 in 6.4% patients and Clavien 3–4 in 3.2% patients respectively. In histopathology, 19.3%, 58.2 % and 22.5% patients had pT2, pT3a and pT3b respectively. The Gleason score 7, 8 and 9 were present in 9.67%,61.3%. and 29% patients respectively, in the final specimen. The positive surgical margins were present in only 1 (3.2%) patient. At mean follow up of 37.3 months, the continence rate at 3 months and 12 months were 74.2% and 93.5% respectively. The adjuvant radiotherapy was given in 25.8% patients. The biochemical recurrence(BCR) was seen in 19.3% patients with mean time to BCR as 9 months. The early salvage radiotherapy and androgen deprivation therapy was required in only 19.3% patients and 25.8% patients respectively.
3-D Laparoscopic radical prostatectomy in patients with locally advanced high-risk prostate cancer can be offered as first intervention, followed by adjuvant treatment, as multimodality approach. It is feasible, safe with acceptable perioperative morbidity, along with excellent functional and oncological outcomes. Few patients can avoid adjuvant treatment ,while others can delay androgen deprivation therapy. However, it is a technically challenging procedure and should be done by surgeons of significant laparoscopic expertise.