Wide excision of neurovascular bundle at the level of apex – In case of cT3 PCa, we perform wide excision of neurovascular bundles at level of apex especially in the apical tumor involvement cases. Bladder neck has to be widely dissected without attempt any bladder neck sparing if the tumor is located in basis of prostate. Besides, pedicles of prostate have to be widely excised in a close proximity to neurovascular bundles
Transperitoneal Techniques – Transperitoneal techniques can provide a wide excision of pelvic and iliac lymph nodes. Tewari et al. described a novel transperitoneal RALP technique for visualizing the apex of prostate during RALP . Curto et al described early access to seminal vesicles with a wide and radical excision for providing negative surgical margins at the first step and help to determine the dissection line . Nevertheless, the aim of RP is similar in terms of widely excision of prostate and providing negative surgical margins in case of cT3 PCa via extraperitoneal or transperitoneal routes.
Surgeon experience and volume – Vara et al.reported better oncological results with robotic surgery with growing surgical experience especially among higher volume surgeons . The RALP and notably LRP are definitively not for beginners for cT3 PCa cases and have to be performed by experienced high volume surgeons.
An increasing number of cT3 PCa patients have been recently undergone RP. Recently, Touijer et al. reported open RP in selected patients with advanced stage PCa . We previously reported LRP in T3 PCa patients with similar overall survival rates with T1 and T2 PCa patients [8, 9]. Additionally, RALP series on T3 PCa patients are increasing with high volume patients.
LRP and RALP are promising minimally invasive treatment options in T3 PCa patients . These can provide similar oncological and functional results with open surgery [8, 9]. However, patients can recover faster than open surgery with well-known advantages of minimally invasive surgeries. On the other hand, there is a still financial problem in RALP in terms of robot and its arms are still expensive [8, 9]. Thus, LRP is one step ahead but it needs more practice and is difficult to perform for beginners in laparoscopy. Additional therapies may be needed after surgery . Side effects of these should be discussed with patients and their partners. The HT may reduce sexual desire and can cause to erectile dysfunction. The RT may cause to some bowel and voiding problems. Nevertheless, patients should be informed for all these above.
Despite the limited data above, and we know that the importance of cancer specific survival in PCa. However, similar overall survival rates can be provided in cT3 PCa patients with cT1 and cT2, by LRP in terms of well-known advantages of laparoscopy [8, 9]. Finally, LRP is a plausible surgical option like upon surgery providing considerable oncological and functional results in advanced stage PCa.
LRP seems to be effective and safe in patients with cT3 PCa. Technical difficulties may occur, but similar overall survival rates with cT1 and cT2 can be provided in cT3 patients. Additional therapies may be needed after surgery. LRP can be a reasonable part of treatment in cT3 PCa patients with well-known advantages of laparoscopic surgery.
Akin Y, Yuksel K, Bassorgun I, et al. The consistency of Gleason scores may affect the operation outcomes for laparoscopic radical prostatectomy: a single surgeon and a single pathologist data. Eur Rev Med Pharmacol Sci. 2013;17:123–9.PubMed