Impact of three-dimensional prostate models during robot-assisted radical prostatectomy on surgical margins and functional outcomes.

Abstract

BACKGROUND Robot-assisted radical prostatectomy (RARP) is the standard surgical procedure for the treatment of prostate cancer. RARP requires a trade-off between performing a wider resection in order to reduce the risk of positive surgical margins (PSMs) and performing minimal resection of the nerve bundles that determine functional outcomes, such as incontinence and potency, which affect patients' quality of life. In order to achieve favourable outcomes, a precise understanding of the three-dimensional (3D) anatomy of the prostate, nerve bundles and tumour lesion is needed. STUDY DESIGN This is the protocol for a single-centre feasibility study including a prospective two-arm interventional group (a 3D virtual and a 3D printed prostate model), and a prospective control group. ENDPOINTS The primary endpoint will be PSM status and the secondary endpoint will be functional outcomes, including incontinence and sexual function. PATIENTS AND METHODS The study will consist of a total of 270 patients: 54 patients will be included in each of the interventional groups (3D virtual, 3D printed models), 54 in the retrospective control group and 108 in the prospective control group. Automated segmentation of prostate gland and lesions will be conducted on multiparametric magnetic resonance imaging (mpMRI) using 'AutoProstate' and 'AutoLesion' deep learning approaches, while manual annotation of the neurovascular bundles, urethra and external sphincter will be conducted on mpMRI by a radiologist. This will result in masks that will be post-processed to generate 3D printed/virtual models. Patients will be allocated to either interventional arm and the surgeon will be given either a 3D printed or a 3D virtual model at the start of the RARP procedure. At the 6-week follow-up, the surgeon will meet with the patient to present PSM status and capture functional outcomes from the patient via questionnaires. We will capture these measures as endpoints for analysis. These questionnaires will be re-administered at 3, 6 and 12 months postoperatively.