Robot-Assisted Radical Prostatectomy for Locally Advanced Prostate Cancer
Posted: Thursday, July 5, 2018
Although robot-assisted radical prostatectomy (RALP) currently represents the most commonly performed surgical procedure in men with localized prostate cancer, its role in treating those with locally advanced prostate cancer has not been well investigated. With that in mind, Takashi Saika, MD, PhD, of Ehime University Graduate School of Medicine, Matsuyama, Japan, and colleagues conducted an analysis of the current medical literature regarding RALP and concluded the procedure should be considered as a primary therapy in a multimodal approach to treating patients with locally advanced prostate cancer. Locally advanced prostate cancer, in this analysis, was characterized by extracapsular extension (T3a), invasion of the seminal vesicles (T3b), or invasion of other adjacent organs (T4) experientially.
“Further studies are required to confirm the effectiveness of RALP at long-term follow-up in this clinical scenario,” Dr. Saika and colleagues commented.
In the analysis, published in the International Journal of Urology, the authors noted that recent reviews comparing RALP with open radical prostatectomy have shown similar to superior rates of positive surgical margins and biochemical recurrence, with decreased blood loss and the need for blood transfusion. The authors emphasized that the advantages of RALP performed by skilled surgeons include tissue magnification and recognition as well as tridimensional vision, which may result in improved urinary continence recovery, even in the context of extended wide resection.
The diagnosis potential of extended pelvic lymph node dissection (PLND) was also emphasized in the study. A main benefit of extended PLND is that patients found to have nodal metastasis may be immediately considered for early adjuvant therapy. The authors concluded that RALP and extended PLND may be considered as the standard for accurate nodal staging and local disease control, especially for patients with lymph node metastasis.