Rapports de cas cliniques et médicaux

Robotic-assisted Radical Prostatectomy in a ≥ 350 grams Prostate: A Case Report from an High-Volume Robotic Center

Abstract

Kobe Van Hove, Louise Callens, Floor Vanelderen, Iraj Ahmadzai, Louis-Philippe Boret, Luca Sarchi, Marco Paciotti, Angelo Mottaran, Adele Piro, Luigi Nocera, Pieter De Backer, Fernando Gonzales-Meza, Ruben De Groote, Alexandre Mottrie and Carlo Andrea Bravi

Background: Radical prostatectomy is among gold standard treatments for prostate cancer (PCa). As compared to other surgical approaches, robot-assisted radical prostatectomy (RARP) offers several advantages such as better intra-operative manipulation and lower peri-operative morbidity and as such, it is currently the preferred surgical option whenever available. In candidates to RARP, a large prostate is often a challenge as it may affect operative and functional outcomes, but can be safely performed according to current literature. However, studies of RARP involving a large prostate were often limited to a weight ranging from 50 to 150 grams, with only few cases of RARP performed on bigger prostate glands. For this reason, we want to describe a case of a patient with a prostate larger than 350 grams treated with RARP at our institution.

Case report: We presented a case of a 68-year-old patient that came for a second opinion following a diagnosis of prostate carcinoma after an elevated PSA of 21 ng/ml without the presence of lower urinary tract symptoms. Magnetic resonance imaging showed a PIRADS 5 lesion in the left apex with an estimated weight of 450 grams. Biopsy showed an International Society of Urological Pathology (ISUP) group-3 adenocarcinoma. RARP was performed using an anterior, trans-peritoneal approach. The operative time was 210 minutes, and the estimated blood loss was 1400 ml. Pathological examination showed a pT3b, ISUP group 3 invasive PCa, with negative surgical margins. After surgery, the patient was discharged after two days without postoperative complications, and the urethral catheter was removed after 5 days. At a follow-up visit 30 days after surgery, the patient had neither voiding problems nor urinary incontinence.

Conclusion: We described a case of a patient with an extremely large prostate who underwent robot-assisted radical prostatectomy for prostate cancer. Our findings suggest that a large prostate size is not an absolute contraindication for RARP, with optimal recovery of urinary continence early after surgery. Further research, especially larger studies with longer follow-up, is awaited in order to accurately evaluate outcomes of RARP in patients with large prostates.