Ricardo Soares

Laparoscopic radical prostatectomy for high-risk prostate cancer

To investigate the results of performing laparoscopic radical prostatectomy (LRP) in patients with high‐risk prostate cancer (HRPC): PSA level of ≥20 ng/mL ± biopsy Gleason ≥8 ± clinical T stage ≥2c.

Minimum 5-year follow-up of 1138 consecutive laparoscopic radical prostatectomies

To investigate the long‐term outcomes of laparoscopic radical prostatectomy (LRP).

Long-term oncological outcomes and toxicity in 597 men aged ≤60 years at time of low-dose-rate brachytherapy for localised prostate cancer

To report oncological and functional outcomes of men treated with low‐dose‐rate (LDR) prostate brachytherapy aged ≤60 years at time of treatment.

Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience:

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2–T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155–266) vs 223 (interquartile range=100–238) min; p=0.05) and catheterisation (8 (interquartile range=8–8) vs 14 (interquartile range=14–14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 (p=0.65) and 31.8% vs 14.3% for pT3 (p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively (p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% (p<0.0001), 32.5% (p=0.01) and 30% (p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0–1 pads/day.

Lymph node parameters and complications following laparoscopic extended pelvic lymphadenectomy for prostate cancer in 1000 consecutive patients

Objective: The purpose of this study was to investigate the short-term results of extended pelvic lymphadenectomy (ePLND) during laparoscopic radical prostatectomy (LRP). Patients and methods: Of 1330 consecutive patients undergoing LRP during a 90-month period 1000 (75%) had an ePLND for d’Amico intermediate- or high-risk prostate cancer. Results: Operating time, blood loss, conversion and transfusion rates and hospital stay were similar in patients having standard pelvic lymphadenectomy (sPLND) and ePLND. Median lymph node count was significantly greater following ePLND vs sPLND (17 vs 6; p⩽0.0001). Complication rates were also similar but trended (p=0.06) towards a greater rate after ePLND vs sPLND: 9.0% and 5.5%. Lymph node involvement (LNI) was detected more frequently following ePLND in patients with: prostate specific antigen (PSA)=0–9.9 (p=0.01) and PSA=10–19.9 (p⩽0.0001); biopsy Gleason sum ⩽8 (p⩽0.0001 to 0.03); intermediate- (p⩽0.0001) and high-risk (p⩽0.0001) cancer; pathological Gleason grade 7 (p⩽0.0001) and pathological stage T3 (p=0.0009 for pT3a and p⩽0.0001 for pT3b). Conclusion: ePLND is a more effective tool than sPLND in detecting LNI for patients in all prognostic clinical groups. This can be achieved without significant penalty with respect to operating time or complication rates.