The Precision Prostatectomy: A Novel Surgical Form Of Focal Therapy

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-11 THE PRECISION PROSTATECTOMY: A NOVEL SURGICAL FORM OF FOCAL THERAPY Akshay Sood, Wooju Jeong, Mohit Butaney, Isaac Palma-Zamora, Michael Gorin, Firas Abdollah, and Mani Menon Akshay SoodAkshay Sood More articles by this author , Wooju JeongWooju Jeong More articles by this author , Mohit ButaneyMohit Butaney More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Michael GorinMichael Gorin More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , and Mani MenonMani Menon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We recently described a novel surgical form of focal therapy for prostate cancer (CaP) treatment -- the precision prostatectomy. Here we report on the functional and oncological outcomes of the first 88 consecutive patients. METHODS: Men who met the criteria: 1) PSA ≤15 ng/mL, 2) stage ≤cT2, 3) dominant unilateral lesion with Gleason ≤4+3 with any number or % of cores involved ipsilaterally on biopsy, 4) no primary Gleason ≥4 contralaterally, and 5) preoperative erectile function score (IIEF-5) of ≥17/25 with/without PDE-5i were included in this prospective, single-arm, IDEAL stage 2b study (Dec 2016-Jan 2020). Safety of the precision prostatectomy technique, and urinary, sexual and oncological outcomes were studied. Descriptive statistics and Kaplan-Meier analysis were used to assess 12-month urinary continence (0-1 pad), 12-month sexual potency (SHIM ≥17), and 36-month freedom from clinically-significant CaP (grade group ≥2), secondary treatment, metastatic disease and mortality. RESULTS: At study-entry, the median (IQR) age, PSA and SHIM scores were 60 (54.2-65.9) years, 5.7 (4.2-7.1) ng/mL and 22 (19-24), respectively. All patients were followed for a minimum of 6 months. At 12-months, from a functional standpoint, all (100%) patients were continent (0-1 pads), with 90.9% of the patients using 0 pads (Figure 1a). The median (IQR) time to urinary continence was 1 (1-4) months. 85% of all-comers were potent at 12-months, while 90.2% of the preoperatively potent patients were potent at 12-months (Figure 1b). The median SHIM score was 21 at 12-months. The median time to sexual potency was 4 (4-12) months. From an oncological standpoint, at 36-months, 6.6% of the patients were found to have clinically-significant residual CaP on follow-up biopsies, and 9.3% had required secondary therapy (removal of the remnant tissue). All patients were alive and free of metastatic disease at the latest follow-up (Figure 1c). CONCLUSIONS: Precision prostatectomy is technically safe, and offers excellent postoperative functional results. At 36-months of follow-up, the oncological outcomes and secondary treatment rates were at least at-par with the ablative forms of focal therapy. Pending long-term data from prospective studies, a risk-stratified surgical approach to CaP may avoid whole-gland therapy and preserve functional QoL in men with CaP. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e366-e366 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood More articles by this author Wooju Jeong More articles by this author Mohit Butaney More articles by this author Isaac Palma-Zamora More articles by this author Michael Gorin More articles by this author Firas Abdollah More articles by this author Mani Menon More articles by this author Expand All Advertisement Loading ...