Albers P et al. (2007) Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer. BJU Int 100: 1050–1054

Retropubic radical prostatectomy (RRP) is the preferred approach for high-risk prostate cancer patients; however, for low-risk patients for whom lymphadenectomy is not required, perineal radical prostatectomy (PRP) is a quicker and more cost-effective procedure. Albers et al. report a new technique of seminal-vesicle-sparing perineal radical prostatectomy (SV-PRP), which reduces the complication rate in select patients compared with RRP and standard PRP.

RP was performed on 507 patients in a three-arm nonrandomized phase II trial, who were allocated to PRP or RRP on the basis of risk assessment. Patients with a PSA level ≤10 ng/ml, Gleason sum ≤7 and prostate volume ≤50 ml were randomly allocated to standard PRP (171 patients) or SV-PRP (147 patients); the remaining 190 patients underwent RRP. Mean operative duration was 90 min for SV-PRP, 141 min for PRP and 164 min for RRP, and the transfusion rate was 3.4%, 10.5% and 10.0%, respectively. Nerve sparing was possible in 90%, 62% and 57% of patients, respectively. There was no oncological difference in outcome between the three arms. After 4 weeks, 62% of SV-PRP patients achieved full continence, compared with 45% of PRP patients and 44% of RRP patients. After 12 months, these rates were 96%, 86% and 66%, respectively.

The authors conclude that SV-PRP reduces surgical time and complications for low-risk patients, and would be recommended if long-term oncological data prove to be favorable.