Preventative Function-sparing Radical Prostatectomy: Experience in a Tertiary Referral Centre.

BACKGROUND AND

OBJECTIVE

The oncological and functional outcomes after preventative radical prostatectomy (pRP) are unknown. Our aim was to assess functional and oncological outcomes and the patient perspective, motivation, and postprocedural experiences of a highly selected pRP cohort.

METHODS

We identified patients who underwent pRP between 2012 and 2021 in a single high-volume centre without a prostate cancer (PCa) diagnosis before surgery. Functional and oncological outcomes were assessed via validated questionnaires. In-depth semistructured interviews were conducted with the patients about their pRP experience.

KEY FINDINGS AND LIMITATIONS: Seven patients who ranged in age from 37 to 57 yr underwent pRP. Final pathology revealed PCa in 71% of cases, which was International Society of Urological Pathology grade group 1 in two patients, and grade group 2 in three. The mean distress score was 7.7 points before pRP versus 1.3 points after surgery. At ≥12 mo after pRP, all the patients had erections firm enough for intercourse and were fully continent. A significant improvement in quality of life was reported because of mental relief and maintenance of physical functioning. The interviewees emphasised the importance of patient-centred medicine. Limitations include the small sample size, lack of a control cohort, and the single-centre setting.

CONCLUSIONS AND CLINICAL IMPLICATIONS: No patient regretted his decision after pRP and all patients were free of recurrence. For men with a serious fear of PCa that causes them distress and affects their quality of life, pRP could be a good option outside of guideline recommendations if performed by experts for well-informed patients. Improvements in the legal foundation for this approach are needed.