Presented by: Hal Kominsky
UT Southwestern Medical Center

Introduction

Treatment of prostate cancer (PCa) in men with prostatomegaly is challenging due to the increased risk of stress urinary incontinence (SUI) post-radical prostatectomy (RP) and worsening lower urinary tract symptoms (LUTS) or retention post-radiation therapy (RT). We propose that simple prostatectomy (SP) followed by RT improves symptomatic LUTS, treats cancer, and minimizes SUI versus RP alone. This is an initial analysis of oncologic and functional outcomes for men who underwent SP with RT versus RP

Materials

A retrospective review was conducted in which men with prostatomegaly (>80 mL) on magnetic resonance imaging (MRI) and biopsy-proven PCa were treated with RT after robotic-assisted SP (RASP). These men were compared against a 1:1 propensity score matched cohort of men treated with robotic-assisted RP (RALP) based on prostate volume, age, and body mass index (BMI).

Results

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Thirteen men were included in both RASP+RT and RALP cohorts. Between the two cohorts (Table 1), there were no significant differences in age (73.0 vs 73.0, p = 0.88), volume (135.0 mL vs 135.0 mL, p = 0.92), BMI (30.7 kg/m2 vs 28.4 kg/m2, p = 0.53), or PSA (13.0 ng/mL vs 10.3, p = 0.53). RASP operative time was less than half that for RALP (126 min vs 315 min, p < 0.001). Full, partial, and non-nerve sparing was performed in 4 (31%), 5 (38%), and 4 (31%) RALP patients. No men experienced SUI in the RASP+RT group while 92% and 88% experienced SUI in the RALP group at 3 and 6 months. One man had an artificial urinary sphincter placed after RALP. There were no high-grade complications in the RASP+RT group although 2 men required bladder irrigation for clot retention. One RALP patient experienced ileus requiring nasogastric tube and deep vein thrombosis requiring anticoagulation. Another RALP patient developed a pelvic abscess requiring drain placement. Metastases developed in 2 (15%) men after RASP + RT and in 2 (15%) men after RALP; 2 (15%) others had biochemical recurrence after RALP.

Conclusion

For men with prostatomegaly and PCa, staged treatment with RASP followed by RT offers an alternative to RALP with shorter operative times and better urinary control at 6 months. Further oncologic and functional data will help evaluate the durable success of this novel treatment pathway.

Funding

None.

Lead Authors

Samuel Gold,
UT Southwestern Medical Center

Co-Authors

Ross Gillum,
UT Southwestern Medical Center

Caleb Ashbrook,
UT Southwestern Medical Center

Isaac Palma Zamora,
isaacpalmazamora@gmail.com

Daniel Segal,
isaacpalmazamora@gmail.com

Tara Morgan,
Duke University

Ramy Goueli,
UT Southwestern Medical Center

Jeffrey Gahan,
UT Southwestern Medical Center