EURURO Vol. 72 No. 3

Platinum Priority – Prostate Cancer

Editorial by Akshay Sood, Firas Abdollah and Mani Menon on pp. 343–344 of this issue

Partial Prostatectomy for Anterior Cancer:

Short-term Oncologic and Functional Outcomes

Arnauld Villers

a , b , * ,

Philippe Puech

b , c ,

Vincent Flamand

a ,

Georges-Pascal Haber

d ,

Mihir M. Desai

e ,

Sebastien Crouzet

f ,

Xavier Leroy

g ,

Sameer Chopra

e ,

Laurent Lemaitre

b , c ,

Adil Ouzzane

a , b ,

Inderbir S. Gill

Department of Urology, CHU Lille, Universite´ de Lille, Lille, France;

Inserm, U1189 - ONCO-THAI, CHRU Lille, Universite´ de Lille, Lille, France;

Department

of Radiology, CHU Lille, Universite´ de Lille, Lille, France;

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA;

USC Institute of

Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA;

Urology and Transplantation

Department, Edouard Herriot Hospital, Universite´ de Lyon, Lyon, France;

Department of Pathology, CHU Lille, Universite´ de Lille, Lille, France

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 3 3 3 – 3 4 2

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted August 25, 2016

Associate Editor:

Giacomo Novara

Keywords:

Prostatectomy

Focal therapy

Prostate cancer

Magnetic resonance imaging

Image-guided intervention

Minimally invasive surgery

Robotic surgery

Please visit

www.eu-acme.org/ europeanurology

to read and

answer questions on-line.

The EU-ACME credits will

then be attributed

automatically.

Abstract

Background:

Focal ablative therapy may be a suboptimal option for anterior prostate cancers

(APCs) reaching the prostate apex due to concerns for thermal injury to the external sphincter.

Objective:

To explore the technical feasibility of anterior partial prostatectomy (APP) for

isolated APCs detected by magnetic resonance imaging (MRI), and to report short-term

oncologic and functional outcomes.

Design, setting, and participants:

Following institutional review board approval, over an 8-yr

period (2008–2015) 17 consenting patients were enrolled in a prospective single-arm single-

center Innovation, Development, Exploration, Assessment, Long-term (IDEAL) phase 2a study.

Inclusion criteria comprised preurethral, low- to intermediate-risk APC diagnosed by MRI, and

targeted biopsies. Robotic template APP was performed; posterolateral aspect of the sub-

montanal urethra, peripheral zone, and periprostatic tissues were preserved intact. Median

follow-up was 30 mo (interquartile range [IQR]: 25–70).

Outcome measurements and statistical analysis:

We noted the incidence of perioperative

complications and examined reports of pathology, prostate-specific antigen (PSA), imaging,

biopsies, and questionnaires.

Results and limitations:

Preoperatively, median PSAwas 9.8 ng/ml, Gleason score was 6–7 (3 +

4), and cancer volume was 3.7 cm

(IQR: 1.7–4.6). The technique was feasible in all cases.

Perioperative complications included anastomotic leak (12%; G2), urinary tract infection (6%;

G2), and transient intestinal ileus in one case (6%; G2). At 3 mo, continence and potency rates

were 100% and 83%, respectively. Median nadir PSA was 0.4 ng/ml (IQR: 0.3–0.7). All margins

and posterolateral margins rates were 55% and 35%, respectively. APC recurrence-free survival

at 2 yr was 0.86 (95% confidence interval [CI], 0.55–0.96). Four patients (24%) who recurred

underwent an uncomplicated completion of robot-assisted prostatectomy. Regarding limita-

tions, CIs are quite wide for reported outcomes.

Conclusions:

Robotic partial prostatectomy for isolated APC is feasible with good functional

results. While promising, much more research is needed to verify our initial outcomes and

appropriately position APP in the treatment paradigms for APC.

Patient summary:

We explored a novel approach for partial prostatic surgical ablation for

prostate cancer located in the anterior part of the prostate as an alternative to other focal

ablative techniques.

* Corresponding author. Department of Urology, CHU Lille, Universite´ de Lille, F-59000 Lille, France.

Tel. +33 (0) 3 20 44 42 35; Fax: +33 (0) 3 20 44 42 35.

E-mail address:

arnauld-villers@univ-lille2.fr

(A. Villers).

http://dx.doi.org/10.1016/j.eururo.2016.08.057

0302-2838/