Hsu Chao-Yu, Yang Che-Hsueh, Tung Min-Che, Liu Hung-Jen, Ou Yen-Chuan
Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung 435, Taiwan.
Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan.
Cancers (Basel). 2023 Aug 27;15(17):4288. doi: 10.3390/cancers15174288.
This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies.
Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP. < 0.05 was considered to be significant.
We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84-5.52), < 0.001; continence recovery: 2.25 (1.46-3.48), < 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP.
For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.
本研究旨在探讨治疗诊断型机器人辅助根治性前列腺切除术（T-RARP）对临床高度怀疑但未经活检证实的前列腺癌（PCa）的益处。
2016年2月至2020年12月期间，我们将临床高度怀疑PCa的男性纳入本研究。他们被评估为可能患有局限性PCa且未接受任何初始治疗，并被分为既往活检为良性或未进行活检的类别。此外，将同一时间段内另一组接受RARP的恶性活检患者作为对照组。终点是比较接受RARP的恶性活检与T-RARP之间的肿瘤学结局和功能结局。P<0.05被认为具有统计学意义。
我们纳入了164例经活检证实为恶性且接受RARP治疗的男性作为对照组。对于T-RARP组，我们纳入了192例男性。其中，129例术前活检为良性，63例在T-RARP术前未进行活检。T-RARP组中约75%的男性最终报告显示为恶性病理，另外25%为良性病理。T-RARP具有若干肿瘤学优势，如初始病理T分期更高、Gleason分级更低以及手术切缘阳性几率更低。然而，生化复发率并未显著降低。在我们的队列中，T-RARP（优势比及95%置信区间；勃起功能恢复：3.19（1.84 - 5.52），P<0.001；控尿功能恢复：2.25（1.46 - 3.48），P<0.001）与接受RARP的恶性活检相比，能带来更好的功能结局恢复。
对于临床高度怀疑的PCa，T-RARP能够检测出约75%的PCa病例，并最大程度地保留其功能结局。然而，在25%病理为良性的男性中，约6%会出现尿失禁，10%会出现勃起功能障碍。对于考虑T-RARP的潜在人群，这部分情况应充分告知。
