VM89 - Pelvic Exenteration in Symptomatic Prostate Adenocarcinoma

Saturday, June 1, 2024

10:00 AM – 1:30 PM ET, USA

Location: Baltimore Convention Center, Hall BCD

Video Presentation(s)

Jacob Neary, MD, MS

Resident
MedStar Georgetown University - MedStar Washington Hospital Center
Medstar Washington Hospital Center-Georgetown University Hospital
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

ND

Noosha Deravi, MD

Resident
MedStar Georgetown University - MedStar Washington Hospital Center
Washington, District of Columbia, United States

Disclosure information not submitted.
BM

Belen Mora, MD

Resident
MedStar Georgetown University - MedStar Washington Hospital Center
Washington, District of Columbia, United States

Disclosure information not submitted.

Senior Author(s)

ZS

Zhifei Sun, MD

Assistant Professor of Surgery
MedStar Georgetown University Hospital
Falls Church, Virginia, United States

Disclosure information not submitted.

Author(s)

Mohit Gupta, MBBS DNB MRCS

Registrar (Surgical Resident)
Salisbury district hospital
Salisbury District Hospital
Southampton, England, United Kingdom

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Prostate cancer is the second most common cancer in males. The majority (>95%) are slow-growing adenocarcinomas. Detection is based on serial monitoring of prostate-specific antigen (PSA) starting at age 50 with or without digital rectal examination. Biopsy is the gold standard for diagnosis, however there is approximately a 30% false negative rate. A prostate MRI is a common adjuvant prior to initial biopsy to detect clinically significant prostate cancer.

Methods/Interventions: The procedure was performed on the Da Vinci Xi platform under the utilization of both Urologic surgery and colorectal surgery. The surgery was performed at an academic affiliated hospital in the elective setting.

Results/Outcomes: Patient is a 78-year-old male with benign prostatic hyperplasia, elevated PSA (9.7ng/mL), and a rapidly enlarging pelvic mass (7.3cm). The lesion was in the right peripheral zone of the prostate, involving the bladder and rectum. Transrectal biopsy was negative for malignancy. An MRI was suggestive of an atypical prostate malignancy rather than adenocarcinoma. Subsequent colonoscopy showed an 8cm submucosal mass in the anterior rectum. Biopsies were however non-diagnostic. Due to worsening obstructive symptoms, surgical resection was pursued prior to definitive diagnosis. The patient underwent robotic pelvic exenteration, radical cystoprostatectomy, and abdominoperineal resection with end colostomy. Final pathology revealed prostatic ductal adenocarcinoma (pT4N0). Gleason score was 9 with invasion of the rectum, lympho-vasculature, and perineum.

Conclusion/Discussion: Diagnosis of prostate cancer is difficult due to the insidious nature of the disease. Systematic prostate biopsy continues to be the gold standard, however given the high rate of false negatives, clinically significant prostate cancer can go undetected. If trans-rectal biopsies return negative, MRI-guided biopsy may be warranted. In the case of symptomatic metastatic disease, patients benefit from a multidisciplinary approach.