Endoscopic, Transperitoneal Radical Prostatectomy with 3.0-T mpMRI Stratifies Patients with Advanced Prostate Cancer

Abstract

Objective: Recent years have brought a significant shift in case selection for the surgical treatment of prostate cancer (PCa). Primary surgical management is increasingly implemented in more aggressive tumors, however the role of radical prostatectomy (RP) in advanced cases remains controversial. The aim of the present study is to explore cancer diversity in patients who were subjected to endoscopic, transperitoneal RP due to very high-risk advanced PCa. Methods: Our database was screened for prostate cancer patients with clinically diagnosed seminal vesicles infiltration and/or invasion of other adjacent structures (cT3b-4 N0) and/or suspected nodal involvement (cT1-4 N1) who underwent ERP. Twenty cases were identified: 11 patients with cT3b-4 N0 disease and 9 patients with suspected nodal involvement. The preoperative tumor stage was assessed with the use of multiparametric magnetic resonance (mpMRI) in all cases. Results: Although the accuracy of mpMRI in the assessement of local tumor stage was 85%, the lymph node status was properly assessed preoperatively in 45% cases only. The pT3b-4 PCa was diagnosed in 13 cases (65%). Of them, 9 had lymph nodes metastases. Three patients (15%) were diagnosed with pT3a cancer, among them nodal metastases were confirmed in 2 cases. In the remaining 4 patients (20%), the tumor was confined to the prostate but in 1 of them pelvic lymph nodes were involved. Early, postoperative PSA was lower than 0.2 ng/ml in 13 patients (65%). Seventeen patients (85%) received additional treatment: androgen deprivation therapy in 7 cases (35%), radiation therapy in 10 cases (50%). No pad use was declared by 14 patients (70%). Conclusion: Radical prostatectomy thoroughly stratifies patients diagnosed with advanced prostate cancer. In more than a half of cases the clinical stage differs from the pathological disease status. Correct, postoperative prostate cancer stratification allows to personalize multidisciplinary treatment to reduce toxicity and improve oncological outcome.