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

Abstract

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.