Retzius sparing techniques during RALP

[Wishyouwerehere]

Dear All,Since I live on the other side of the pond then we have a very different health service structure but irrespective of that fact I am very interested in the views of the forum on the cancer treatment which is available to me and how others may have found it.

My story: father and brother both with PC. Hence not a surprise to be diagnosed with pc 3 months ago.

gleason score 3+4 =7 with 0.3mm of malignant cancer in 1 of the 17 core biopsies. MRI image showing small lesion PIRADs 4

Psa level of around 4.5. Went onto active surveillance .

Current psa level 8.8 after 3 months hence send for second high quality mpMRI scan which indicates that lesion more distinct and increased in size which probably indicates the reason for the rise in PSA. Recommended to no longer be on active surveillance due to the quickly increasing lesion and hence some form of curative action be instigated. There is further discussion regarding a second transperineal biopsy.

However in speaking with a urologist surgeon he advised that he could use Retzius-sparing technique, preserve both neurovascular bundles and use intraoperative frozen section (NeuroSAFE) to check that my surgical margins are clear when removing the prostate via use of a DeVinci machine.

This is what such an operation looks like youtube.com/watch?v=uNZm3GI...(Not working as expected?)

These operations allegedly have very good results in the preservation of continence with around a five fold increase in rates over conventional prostate surgery. The reason is that instead of attacking the prostate from the front and damaging the Retzius region where there are lots of attachments then they attack the prostate from the back and hence spare the important Retzius region when it comes to continence.

I now have a second appointment with a radiologist and I will discuss SBRT and whatever else they may put forward as an options using radiation.

I suppose in the first instance I am keen to ask the question about Retzius sparing procedure and whether or not it is a reasonable common operation in USA and if it is then are the men who have had it reasonably content that it all went well and has minimised the post operation side effects moving forward?

As I say it would be useful to get some comments from men who have undergone the procedure just so as I can get a bit of a feel as to rule this surgery in or out as an option ?

Many thanks in anticipation .

[Tall_Allen]

Retzius sparing is increasingly common in the US. Here's a comparative trial from Italy:

pubmed.ncbi.nlm.nih.gov/364...

I'm glad you are exploring other options.

[Wishyouwerehere]

Dear Tall AllenMany thanks for taking the time to respond. Much appreciated

Thanks for the link to a medical paper which suggests that the claim of significant improvements in continence recovery are correct.

I will be exploring radiation as a cure and I am very interested in CyberKnife SBRT however currently there are only a handful of centres in UK who use SBRT since many other centres offer the standard approach of a course of 20 sessions. However it seems that the shorter SBRT has advantages hence the reason why I am keen to explore this as an option.

Maybe I can indulge your good nature further since I note that you are a person who underwent SBRT then what key points that you believe I should be drilling down on when discussing the issue with the radiologist as to what they can do for me?

Kind regards

[NotDFL in reply to Wishyouwerehere]

Experience with SBRT is of utmost importance, of course. Therefore, you can ask how many patients they have treated and how they do the planning. You can also ask whether they would use the protective (SpaceOAR) hydrogel for a case such as yours. The benefits of the latter are not clear, but many radiation oncologists in the USA do insert the gel. Tall Allen is not enthusiastic AFAIK.

I had SBRT ten years ago and have tried to stay abreast of the therapy.