Wide excision radical prostatectomy may benefit intermediate- or high-risk prostate cancer patients

The authors aimed to determine cancer-related and quality-of-life outcomes when treated with two different types of robot-assisted laparoscopic radical prostatectomy. 

Robot-assisted laparoscopic radical prostatectomy (removal of the prostate) (RALP) is a robotic technique that allows accurate and careful removal of the prostate, seminal vesicles (glands that create semen) and occasionally lymph nodes (sites that contain the immune cells) with minimal damage to surrounding tissue. This reduces the risk of problems occurring after surgery.

Wide resection is used in intermediate and high-risk prostate cancer and involves removing a large section of diseased tissue as well as some normal tissue surrounding the tumor to ensure maximum cancer removal. It can be beneficial in patients who have increased cancer burden (large number of tumors) and has been used in conjunction with RALP.

The aim of this study was to determine cancer-related and urinary outcomes in patients treated with wide resection RALP and non-wide resection RALP.

483 patients were used, 129 (26.7%) underwent wide resection RALP and 354 (73.3%) underwent non wide resection RALP. The follow-up time was 18 months.

At the beginning of the study, clinical disease (recognizable sign and symptoms of cancer based on tumor stage and Gleason score [scoring system used to compare the differences between normal and cancer cells]) was more advanced in patients who received wide resection RALP. Pathologic disease (disease interference with body structures and functions) was worse in wide resection RALP patients.

Wide resection RALP decreased the odds of experiencing positive surgical margins (tissue at the site of prostate removal that still contains cancer) by 27%, but this was not deemed to be statistically significant. 

Extraprostatic extension (spread of the tumor outside of the prostate), seminal vesicle invasion (spread of cancer into the seminal vesicles) and positive lymph node (spread of cancer into the lymph nodes) occurred at a higher rate in wide resection RALP patients than in non-wide resection RALP patients.

Biochemical recurrence-free survival (survival time in which PSA [protein in the blood that is elevated when prostate cancer is present] levels do not rise) was 36 months in wide resection patients compared to 96 months in non-wide resection patients. Patients who received wide resection had significantly reduced urinary control compared to those who received non-wide resection.

The authors conclude that using wide resection robot-assisted laparoscopic radical prostatectomy may benefit patients with high tumor burden by decreasing the likelihood of experiencing positive surgical margins. 

The low number of wide resection patients used and limited follow-up time may not allow for accurate comparisons between wide resection and non wide resection RALP. Furthermore, those who underwent wide resection RALP had worse cancer-related features prior to the surgery, and this would impact the outcomes. 

If you are considering RALP, including or excluding wide resection, please consult your doctor for more information regarding the positives and negatives of surgery.