RSP Surgery — the next leapfrog advancement in PC treatment

Even the "gold standard" undergoes continuous improvement. Good summary provided HERE at the "New" Prostate Cancer InfoLink site.

Post Edited (NKinney) : 1/8/2018 7:29:30 AM (GMT-7)

I'd agree that if the Retzius-sparing procedure only speeds up the return to continence for those who will regain it fairly soon anyway (say, within 6 months of surgery), it's not earth-shattering. But if it can significantly reduce the rate of outright failure to return to continence -- the number of men that end up needing an AUS or sling or external catheters -- that's a big deal. Need some studies of ED rates and long-term oncological outcome, too.

Some of your comments are vaild. It IS too early to “jump for joy,” I agree, although I wasn’t planning on doing that anyhow...but knock yourself out.

This is a new technique; additional training is required. It will take a while to become widely available. I agree.

Radical prostatectomy is a complicated surgery. I agree.


For some of your other questions, I would refer you to this Nov 2017 article as a starting place in the European Urology Journal titled ”Will Retzius-sparing Prostatectomy Be the Future of Prostate Cancer Surgery?”

I’ll just copy/paste the first couple sentences for quick reference:

In this month's issue of European Urology, Dalela et al report a randomized clinical trial (RCT) that compares early continence in standard robot-assisted radical prostatectomy (RARP) and in Retzius-sparing prostatectomy (RSP).

The features of this study are peculiar and deserve attention: the authors call it a “pragmatic” RCT, and in our opinion, this is the case. Indeed, it has been conducted using the most robust and severe methodology. It satisfies the internationally recognized CONSORT guidelines; it has been registered in a worldwide-known database (clinicaltrials.gov). It is a single-surgeon study; the results were evaluated by an independent third party, using an objective method (pad weight); outcome assessment was blinded to the procedure; and the surgical team had no access to outcome files.

The Retzius-sparing approach resulted in statistically and clinically significant advantages as regards immediate continence recovery, whatever parameter was considered: rate of no-pad patients, number of pads, weight of pads, urinary bother, and urinary function questionnaires.

Moreover, we have the feeling that in real-life clinical practice, the difference between the two approaches could be more pronounced...

My crystal ball tells me that "next leapfrog advancement" may be how it will be described 1- or 2-years hence...I'm just providing an advanced read-out. The the Vattikuti Institute Prostatectomy approach (aka, the veil of aphrodite) from almost a decade ago was the last real leapfrog, although there's been other documented (with or without RCT) "continuous improvement" steps along the way...leapfrog or not, RSP certainly is another step forward for the gold standard.


BTW, ddyss, this won't help either you or I, but will be helpful to men in the future and potentially for men on AS right now who perhaps didn't jump the gun into an aggressive treatment before it was needed.

Post Edited (NKinney) : 1/8/2018 11:47:29 AM (GMT-7)

Gemlin said...
...arteries to the penis that allow erections pass through the "cave of Retzius" - the area that is bounded by the pubic bone in front and the prostate behind - which is saved with the Retzius-sparing prostatectomy (RSP).

I'm very interested about the "artery-sparing" aspect (even though it's too late to make a difference for me). When I was researching RP after dx, I found a lot about nerve-sparing procedures, but little about whether a particular procedure or surgeon had a better track record of preserving blood flow. The literature centered on what the patient can do post-RP to maintain blood flow (VED, PED5 inhibitors).
BTW, could the medical community please agree not to add new "R"s to PCa acronyms? Radical, robot, retropubic, radiation -- now Retzius. Sheesh.

Next time I have a prostatectomy, I'll ask for that procedure.