Novel Treatment Pathway for Prostate Cancer Patients

Strategic Insights -

A multicenter study has proposed an alternative approach to radical prostatectomy for men with clinically significant prostate cancer and marked prostatomegaly. The research, conducted by a team of urologists from Duke University Medical Center, reports on the feasibility and safety of robotic simple prostatectomy followed by external beam radiation therapy (EBRT). The study, published in the Canadian Journal of Urology, describes a proof-of-concept study involving 17 patients with prostate cancer who underwent the novel treatment pathway between 2015 and 2023.

Key Takeaways:

  • The study found that robotic simple prostatectomy followed by EBRT was a safe and effective treatment option for men with marked prostatomegaly and prostate cancer, with no postoperative or post-EBRT complications reported.
  • The median time from robotic simple prostatectomy to EBRT was 9 months, and the median prostate size was 135 g.
  • 76.5% of patients received a pre-EBRT rectal spacer, and the median International Prostate Symptom Score (IPSS) score improved significantly from 13.5 preoperatively to 2.5 at 90 days post-RASP, and maintained a median IPSS of 4 at 3 months post-EBRT.
  • No patients with localized disease and PSA data had recurrence during the study period, suggesting that this treatment pathway may be a viable alternative for men with clinically significant prostate cancer and marked prostatomegaly.
  • The study concludes that this novel treatment pathway is a feasible and safe option for men who are unwilling to undergo radical prostatectomy.

Statistics:

  • 17 patients underwent robotic simple prostatectomy followed by EBRT between 2015 and 2023.
  • Median prostate size was 135 g (IQR 110-165).
  • 13 (76.5%) patients received a pre-EBRT rectal spacer.
  • Median IPSS score improved from 13.5 preoperatively to 2.5 at 90 days post-RASP.
  • Median IPSS at 3 months post-EBRT was 4.
  • No postoperative or post-EBRT complications were reported.
  • Median follow-up time was 12 months.

Sources:

  • Canadian Journal of Urology, "Simple prostatectomy followed by radiation therapy for prostate cancer: a novel treatment pathway for men with marked prostatomegaly and prostate cancer: a series of cases" (2025;32(4):309-315)
  • Duke University Medical Center, Durham, NC, USA
  • Tara Morgan, Rafael Tua Caraccia, Daniel Segal, Joshua Kim, Sarah Attia, Neil B. Desai, and Jeffery Gahan, authors of the study.