Patient Details
Age/Sex: 63-year-old male
Diagnosis: Localized Prostate Cancer (cT2aN0M0)
Comorbidities: Hypertension, Type 2 Diabetes Mellitus, Coronary Artery Disease (post-PTCA)
Overview
The patient presented with mild obstructive lower urinary tract symptoms (LUTS) and was found to have an elevated serum PSA of 10.92 ng/mL. Clinical examination revealed a palpable hard nodule involving less than half of the left lobe. Prostate volume was 31 g with intact capsule and no focal lesion on ultrasound. Significant post-void residual (PVR) of 118/301 mL was noted.
Multiparametric MRI showed a PIRADS 4 lesion in the left mid peripheral zone and a PIRADS 3 lesion at the right base, with no rectal or seminal vesicle infiltration and no significant lymphadenopathy. TRUS-guided 12-core biopsy revealed:
- Right lobe: Benign glands and stroma
- Left lobe: Acinar adenocarcinoma, involving 10–15% of tissue, Grade Group 1 (Gleason 3+3=6), perineural invasion absent 68 Ga PSMA PET CT confirmed organ-confined disease.
Why was Robotic Surgery choosen:
Robotic surgery was chosen for enhanced oncological control, precise nerve preservation, minimal tissue trauma, lower blood loss, and faster recovery.
Surgery Performed: Robot-Assisted Radical Prostatectomy with Bilateral Pelvic Lymph Node Dissection
Key Steps and Robotic Advantages:
- 3D visualization of the prostate located deep in the pelvis near the rectum
- Precision in vesicourethral anastomosis, supporting improved postoperative continence
- Minimally invasive approach: Four 8 mm robotic ports + two assistant ports (5 mm and12 mm)
- Operative time: 4 hours 10 minutes
- Estimated blood loss: 50 mL
Postoperative Outcomes
- Hospital stay: Discharged on postoperative day 2
- Pain management: Oral analgesics twice daily for 4 days; resumed normal activities from postoperative day 1
- Short-term functional outcomes: Returned to normal activity on postoperative day 2 with no complications
Key Takeaways / Learning Points
- Clinical significance: This case highlights the advantages of robotic-assisted surgery for localized prostate carcinoma, including superior oncological control, enhanced nerve preservation, minimal tissue injury, low blood loss, reduced pain, and shorter hospital stay.
- Lessons learned: Localized prostate cancer can be safely and effectively managed using a robotic approach, achieving excellent oncological and functional outcomes.
