13 Jan 2017
Prostate cancer is a disease of old age and mostly present in patients who are in the 6th or 7th decade of their life. With increase in awareness and health check up, patients with prostate cancer are increasingly being detected and are being diagnosed in younger age groups. In review of literature, Robotic Radical Prostectomy for Adenocarcinoma prostate in this age is very rare. We report the youngest Indian male – a 36 year old who underwent Robotic Radical Prostectomy for Adenocarcinoma Prostate. The patient underwent routine health check in Jan 2016 and was detected to have raised serum PSA of 4.6 ng/ml ( Normal less than 4ng/ml ). Digital rectal examination revealed Grade 1 prostate, firm in consistency and non tender. In the family history, his father had Carcinoma urinary bladder and underwent Radical cystectomy with Neobladder formation in 2000 and is doing well and is now under regular follow up. He is married and has one child. The patient was advised repeat PSA after 1 month which was 5.2 ng/ml in Feb 2016. The urine culture report showed growth of gram negative organism and for the same, patient was advised antibiotic course for 2 weeks and repeat PSA. Serum PSA done in June 2016 was 6.13ng/ml.
Patient was advised Dynamic MRI prostate which revealed areas of mild restricted diffusion in bilateral apical peripheral zones anteriorly appearing hyperintense in DWI and hypointense on ADC map. Further, TRUS guided 12 core prostate biopsy was done in Nov 2016. It revealed Adenocarcinoma prostate with perineural invasion. 7 out of 12 cores were positive and Gleason score was 6 (3 + 3). A review of biopsy report was taken, which showed similar findings and 9 out of 12 cores were positive. Patient was counseled about all treatment modalities and he opted for Robotic Radical Prostectomy. PSMA PET was done prior to surgery which showed PSMA avid lesion in both lobes of prostate with no evidence of uptake anywhere else. The patient went for cryopreservation as he decided to have another child. Robotic Assisted Radical Prostatectomy with Extended pelvic lymph node dissection & bilateral nerve sparing surgery was performed on 20th December’ 2016. Surgery was uncomplicated. Patient was discharged next day and is now doing well. His final histopathology revealed Adenocarcinoma Prostate, Gleason grade 3+3=6. No extraprostatic extension. All margins and seminal vesicles were normal. Right pelvic Lymphnodes 0/12 and left 0/10 were normal. MCU and catheter removal were done on 7th day. Patient is fully continent and voiding well. He has full control of urine and does not use any pad. Robotic Radical Prostatectomy is a safe procedure and can eradicate complete disease. The patient has good quality of life as before without fear of cancer for life long.
13 Jan 2017