Laparoscopic Pelvic Lymph Node Dissection Combined with Real-time Interactive Transrectal Ultrasound Guided Transperineal Radioactive Seed Implantation of the Prostate

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Abstract
Laparoscopic pelvic lymph node dissection with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation is a new method of treatment for localized carcinoma of the prostate. A total of 58 patients with clinically confined prostate cancer and negative seminal vesicle biopsies underwent staging laparoscopic pelvic lymph node dissection immediately followed by prostate implantation: 50 had125 iodine and 8 had103 palladium implants. Mean operating time was 226 minutes (range 120 to 475), mean blood loss was 57 cc (range 5 to 400) and average hospital stay was 2.2 days (range 0.5 to 8). At a mean followup of 12 months (range 6 to 24), complications included proctitis in 1.7 percent of the cases, dysuria in 24 percent, nocturia in 21 percent and outlet obstruction in 17 percent. Erectile function remained unchanged. Prostate volume decreased to 58.9 percent of the pretreatment value by 12 months and to 44.3 percent by 24 months. Mean prostate specific antigen level was 18.4 plus/minus 26.3 ng./ml. before treatment, 3.4 plus/minus 3.9 ng./ml. at 6 months, 2.3 plus/minus 2.3 ng./ml. at 12 months and 4.9 plus/minus 6.0 ng./ml. at 24 months (1.2 plus/minus 1.0 ng./ml. for patients with no evidence of disease). Of the patients 15.8 percent had local failure at 18 to 24 months as determined by positive transrectal ultrasound guided biopsy. Five of 58 patients (8.6 percent) had persistently elevated prostate specific antigen levels, only 1 of whom had a positive biopsy. Laparoscopic pelvic lymph node dissection with transrectal ultrasound guided implantation is a safe and promising mode of therapy for patients with localized prostate cancer.