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Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy

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Abstract

Objective

To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP).

Methods

320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien–Dindo (CD) grade ≥ 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad.

Results

Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14–300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD ≥ 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03).

Conclusion

HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.

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Funding

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Stefano Tappero and Paolo Dell’Oglio: These authors equally contributed to the manuscript idealization and realization, and they should be considered as first and co-first author.

Authors and Affiliations

  1. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Stefano Tappero, Paolo Dell’Oglio, Mattia Longoni, Carlo Buratto, Erika Palagonia, Pietro Scilipoti, Enrico Vecchio, Marco Martiriggiano, Silvia Secco, Alberto Olivero, Michele Barbieri, Giancarlo Napoli, Elena Strada, Giovanni Petralia, Dario Di Trapani, Aldo Massimo Bocciardi & Antonio Galfano

  2. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Paolo Dell’Oglio

  3. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Paolo Dell’Oglio

  4. Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy

    Stefano Tappero, Enrico Vecchio & Marco Martiriggiano

  5. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy

    Stefano Tappero, Enrico Vecchio & Marco Martiriggiano

  6. Division of Urology, School of Medicine, Department of Clinical, Special and Dental Sciences, University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Ancona, Italy

    Erika Palagonia

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  1. Stefano Tappero
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Contributions

Tappero: Project development, Data analysis, Manuscript writing. Dell’Oglio: Project development, Data analysis, Manuscript writing. Longoni: Data collection, Data analysis. Buratto: Data collection. Palagonia: Data collection, Data analysis. Scilipoti: Data collection. Vecchio: Data collection. Martiriggiano: Data collection. Secco: Project development, Data analysis. Olivero: Project development, Data analysis. Barbieri: Data collection. Napoli: Data collection. Strada: Data collection. Petralia: Critical revision of the manuscript, Important intellectual content. Di Trapani: Critical revision of the manuscript, Important intellectual content. Bocciardi: Project development, Critical revision of the manuscript, Important intellectual content, Supervision. Galfano: Project development, Manuscript writing, Supervision.

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Correspondence to Stefano Tappero.

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Tappero, S., Dell’Oglio, P., Longoni, M. et al. Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy. World J Urol 40, 1993–1999 (2022). https://doi.org/10.1007/s00345-022-04073-5

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  • DOI: https://doi.org/10.1007/s00345-022-04073-5

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