Introduction: Biochemical recurrence of prostate cancer after definitive therapy with radical prostatectomy (RP) is
known to occur between 25-30%. We present the first known case of 1.5T MRI guided ablation using laser interstitial
thermal therapy (LITT) for locally recurrent prostate cancer following RP.
Methods: The patient elected to undergo MRI-guided LITT of the biopsy proven cancer recurrence using an FDAapproved
MRI compatible, 980nm, 15-watt laser system with MR thermometry. Under T2-weighted MR(1.5T Siemens)
imaging, guidance and targeting of the lesions with trans-perineal placement of laser applicators. Multiple cycles of laser
energy were used to ablate the tumor. A MRI-compatible urethral cooling catheter was placed to prevent urethral
thermal damage.
Results: Intra-procedural temperature mapping allowed continuous monitoring of the ablation zone and permitted
ablation control until tumor coverage was achieved. Additionally, the protective cooling effects of the urethral cooling
catheter could also be seen with the temperature mapping. Post-ablation gadolinium and T2 weighted MR imaging
demonstrated an ablation defect encompassing the recurrent tumor with no residual hyper-enhancing nodules. Three
month follow-up shows no residual or recurrent tumor seen on MR imaging.
Conclusion: This represents the first known, successful, MRI-guided, LITT procedures at 1.5T for locally recurrent
prostate adenocarcinoma following RP.
Purpose: To evaluate outcomes among a matched cohort of prostate cancer patients
treated with radical retropubic prostatectomy (RRP) and robot assisted radical
prostatectomy (RARP).
Materials and methods: Between 2002 and 2005, 294 patients underwent RARP at our
institution. Comparison RRP patients were matched 2:1 for surgical year, age, PSA,
clinical stage, and biopsy grade (n=588). Outcomes among groups were compared.
From an oncologic standpoint, pathologic features among groups were assessed and
Kaplan-Meier estimates of PSA recurrence free survival were compared.
Results: Overall margin positivity was not significantly different between groups
(RARP, 15.6%, RRP, 17%), yet risk of apical margin was significantly less with RARP.
RARP was associated with significantly shorter hospitalization (p<0.01) and lower
incidence of blood transfusion (p < 0.01). Early complications were higher in the RARP
group (16% vs 10%, p<0.01). Among late complications, risk of bladder neck
contracture was lower with RARP (1.2%, p=0.02). Adjuvant hormonal therapy was
significantly higher in the RRP group (6.6% p<0.01). Continence at 1 year among
groups was equivalent (p=0.15). Potency at 1 year was better among RARP patients
(p=0.02). At a median followup of 1.3 years, PSA recurrence free estimates were not
significantly different (92% vs 92%, p=0.69).
Conclusions: Early complications were higher in this RARP group, but this experience
includes cases performed in the learning curve. Oncologic, quality of life, and functional
data in this study revealed encouraging results for RARP when compared to RRP.
Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach
have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of
obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to
those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame.
Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to
identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single
surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and
complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square
method and least-squares method of linear regression where appropriate.
Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not
statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP
(p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall
complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive
margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without
therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar.
Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and
functional outcomes when compared to open RRP.
Objective: To define the learning curve for daVinci-assisted laparoscopic radical prostatectomy (DLP) at our institution.
Methods: The data from 170 patients who underwent DLP between August 2002 and December 2004 by a single
surgeon (MTG) were reviewed. Operative time, hemoglobin decrease, conversion to open procedure, positive margin
rates, complications, length of stay (LOS), length of catheterization, continence, and erectile function were analyzed.
Results: Hemoglobin decrease (p=0.11), positive margin rates (p=0.80), and early urinary continence (p=0.17) did not
significantly correlate with surgical experience. A trend towards lower complications (p=0.07) and an earlier return of
erectile function (p=0.09) was noted with increased experience with DLP. Operative time, hospital stay, catheterization
time, and open conversion showed significant association with patient sequence. Median operative time for the first 60
and the last 110 patients was 323.5 and 239.5 minutes (p=<0.0001), respectively. Median LOS for the aforementioned
groups was 53 and 51 hours (p=0.009). Length of catheterization declined significantly between the first 60 and the
remaining 110 patients, 14 as compared to 11.5 days (p=<0.0001). Eight open conversions occurred, six were in the
first 30 patients (p=0.03).
Conclusion: As an indicator of the learning curve, the operative time in our series showed no correlation with sequence
after the 60th patient. Thus, despite the advantages of robotics, the learning curve to efficient performance of daVinciassisted
laparoscopic radical prostatectomy is long. Oncological and functional outcomes should not be affected during
the learning curve.
Conference Committee Involvement (6)
Therapeutics and Diagnostics in Urology: Lasers, Robotics, Minimally Invasive, and Advanced Biomedical Devices
21 January 2012 | San Francisco, California, United States
Urology: Diagnostics, Therapeutics, Robotics, Minimally Invasive, and Photodynamic Therapy
22 January 2011 | San Francisco, California, United States
Urology: Diagnostics, Therapeutics, Robotics, Minimally Invasive, and Photodynamic Therapy
23 January 2010 | San Francisco, California, United States
Urology: Diagnostics, Therapeutics, Robotics, Minimally Invasive, and Photodynamic Therapy
24 January 2009 | San Jose, California, United States
Urology: Diagnostics, Therapeutics, Robotics, Minimally Invasive, and Photodynamic Therapy
19 January 2008 | San Jose, California, United States
Urology: Diagnostics, Therapeutics, Robotics, and Minimally Invasive
20 January 2007 | San Jose, California, United States
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