Can 3D scans improve the outcomes of patients with prostate cancer undergoing robotic removal of the prostate?

This study evaluated the effect of 3-dimensional (3D) digital models to plan robotic-assisted laparoscopic radical prostatectomy (RALP) on the outcomes of patients with prostate cancer (PCa). The data showed that 3D digital models significantly improved the outcomes of these patients.

PCa is one of the most common types of cancer in males. Many patients with PCa need prostate removal surgery (prostatectomy) as treatment. One type of surgery that is most commonly used is RALP. RALP involves the use of a mechanically assisted device (robot) to remove the entire prostate gland.

It is important that a patient has the best outcome with no complications and a high chance of being cancer-free. To optimize success, a surgeon must balance the best chance of completely treating the cancer with a good functional outcome as well as minimum urinary complications. This includes preserving the nerves responsible for erections and the urinary (bladder) sphincter which allows for urine control (continence).

To plan surgery, such as RALP, doctors use 2-dimensional (2D) pictures of the prostate with magnetic resonance imaging (MRI) scans. With advances in technology, the use of 3D models to help guide cancer treatment plans, such as surgery has recently become available. However, the use and impact of patient-specific 3D models on RALP outcomes in patients with PCa are still unknown.  

The study included 92 patients who had PCa and were planning to have RALP. Patients were separated into two groups. Group 1 included 51 patients who had usual therapy planning with standard images (multi-parametric prostate MRI scans) before RALP. Group 2 included 41 patients who had an additional resource of 3D models to plan their RALP. Patients were followed up for an average of 18 months after the surgery.

3 months after surgery, significantly fewer patients in group 2 had detectable prostate-specific antigen (PSA) levels (3.1%) compared to group 2 (19.4%). PSA is a protein produced by the prostate gland and it is used as a marker of PCa. The lower the PSA level, the lower the risk of PCa recurrence. After 18 months, 0% of patients in group 2 had detectable PSA levels compared to 17.9% in group 1. 

Patients in group 1 were significantly more likely to require further treatments after 18 months such as radiation or hormone therapy (31.6%) compared to patients in group 2 (3.1%).

At 18 months after the surgery, significantly more patients in group 2 (64%) had normal sexual function compared to 30% of patients in group 1. The rate of urine control was similar between group 1 (80.6%) and group 2 (78.6%) after 18 months. 

A patient who achieved all three outcomes (undetectable PSA levels, normal sexual function, and urine control) was considered to achieve a trifecta. Significantly more patients in group 2 achieved a trifecta (48%) compared to 10% in group 1.

The study showed that the use of 3D models in patients planning to undergo RALP significantly improved PCa outcomes.

The study looked back at medical records. The patients and the surgeons involved in the study were aware of the study group they were assigned to.