Laparoscopic extended pelvic lymph node (LN) dissection as validation of the performance of [(11) C]-acetate positron emission tomography/computer tomography in the detection of LN metastasis in intermediate- and high-risk prostate cancer.

OBJECTIVES: To evaluate the accuracy of the radiopharmaceutical [(11) C]-acetate combined with positron emission tomography/computer tomography (acetate-PET/CT) in lymph node (LN) staging in newly diagnosed prostate cancer cases. A second aim was to evaluate the potential discriminative properties of acetate-PET/CT in clinical routine. PATIENTS AND METHODS: In a prospective comparative study, from July 2010 to June 2013, 53 men with newly histologically diagnosed intermediate- or high-risk prostate cancer underwent acetate-PET/CT investigation at one regional centre before laparoscopic extended pelvic LN dissection (ePLND) at one referral centre. The sensitivity, specificity and accuracy of acetate-PET/CT were calculated. Comparisons were made between true-positive and false-negative PET/CT cases to identify differences in the clinical parameters: PSA level, Gleason status, lymph metastasis burden and size, calculated risk of LN involvement, and curative treatment decisions. RESULTS: In all, 26 patients had surgically/histologically confirmed LN metastasis (LN+). Acetate-PET/CT was true positive in 10 patients, false positive in one, false negative in 16, and true negative in 26. The individual sensitivity was 38%, specificity 96%, and accuracy 68%. The acetate-PET/CT positive cases had significantly more involved LNs (mean 7.9 vs 2.4, P < 0.001) with larger cancer diameters (14.1 vs 4.9 mm, P = 0.001) and fewer eventually had treatment with curative intent (40% vs 94%, P <0.005), although we lack long-term outcome data. CONCLUSION: Acetate-PET/CT has too low a sensitivity for routine LN staging but the specificity is high. The acetate-PET/CT positive cases have a very high burden of LN spread.

A simple reconstruction of the posterior aspect of rhabdosphincter and sparing of puboprostatic collar reduces the time to early continence after laparoscopic radical prostatectomy.

BACKGROUND: Incontinence is a drawback after radical prostatectomy for prostate cancer. Several surgical methods to improve continence have been described however with contradictory results. OBJECTIVE: To determine whether a modified surgical technique during laparoscopic radical prostatectomy (LRP) improves postoperative continence. PATIENTS AND METHODS: This is a prospective nonrandomized study with two consecutive series of 100 patients in each group. The first group from 2005 to 2008 underwent a standard LRP. The second group from 2009 to 2011 was subjected to a modified LRP by sparing of puboprostatic ligaments, including the preservation of arcus tendineous, and using a simple posterior tension-releasing suture adapting the urethra stump to the bladder before the anastomosis. The patients had the same preoperative work-up and comparable preoperative baseline characteristics. The 2-year follow-up of the patients included a continence questionnaire and International Prostate Symptom Score (IPSS). Urinary peak flow (Qmax) and post-void residual (PVR) volume were assessed at 3 months. Continence was defined as 0-1 pad/day. RESULTS: Only 99 patients were evaluated in each group. The patients had comparable operative characteristics. The continence rates after the modified technique vs the standard were 33% vs 16%, p=0.007 at 1 month; 66% vs 44%, p=0.002 at 3 months; 81% vs 67%, p=0.034 at 6 months; 92% vs 80%, p=0.024 at 12 months; and 95% vs 86%, p=0.05 at 2 years. No significant differences were found regarding voiding functions, the Qmax, the PVR volume, or the IPSS. Three patients developed urethral stricture in the standard group compared with none in the modified group. The negative margin rates were unchanged. CONCLUSIONS: The anterior preservation and posterior suture technique studied is a simple, safe, and efficient method to shorten the time to continence after LRP without adverse effects on voiding or compromising the margin rates.