Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer

Study Type – Therapy (RCT) Level of Evidence  1b

OBJECTIVE

To report a new and improved seminal vesicle-sparing (SV) technique of radical perineal prostatectomy (RPP) as an option for patients with localized prostate cancer, which is currently competing with the retropubic RP (RRP), endoscopic and robotic approaches.

PATIENTS AND METHODS

From July 2003 to July 2006, 507 RPs were undertaken within a three-arm, unrandomized phase II trial. Patients were selected for RPP if they had a prostate-specific antigen (PSA) level of ≤10 ng/mL, a Gleason sum of ≤7 and a prostate volume of ≤50 mL. This group was randomly divided in those having SV-RPP (147 men) and a classical RPP (171); men in the third group with adverse factors were offered a classical RRP (190). The main endpoint of the trial was the early continence rate at 4 weeks after surgery.

RESULTS

The oncological outcome of patients treated with SV-RPP was no different from that of RPP or RRP. Continence rates (0–1 pad/day) at 4 weeks and 12 months after SV-RPP were 61.7% and 96.3%, respectively, and significantly higher than with RPP (P < 0.023) and RRP (P < 0.005). The transfusion rates (3.4%), anastomotic leaks (6.6%) and mean operative duration (90 min) were significantly lower.

CONCLUSIONS

SV-RPP is a better technique in reducing complications during and after surgery for selected patients. Leaving the SV in place did not increase the short-term PSA relapse rates. As the operation was significantly faster and with better early recovery, SV-RPP might be justified if the long-term oncological data confirm the efficacy of the approach.