Efficacy of different types of radical prostatectomy in patients with localized prostate cancer

Background. In recent years, approaches to performing radical prostatectomy have undergone many modifications to reduce postoperative complications. However, controversy over the technique of radical prostatectomy persists from the moment of its appearance to the present day.

Objective: to assess the state of erectile function, the quality of life of patients with localized prostate cancer before surgery and after performing various types of radical prostatectomy, taking into account the safety of cancer progression.

Materials and methods. We examined 127 patients with localized prostate cancer in low and medium risk groups. Depending on the type of radical prostatectomy, patients were divided into three groups: patients with radical retroperitoneoscopic prostatectomy without preserving the neurovascular bundles, patients with unilateral, and patients with bilateral nerve-sparing prostatectomy. Initially and at the annual stage of the study, the state of erectile function, erection rigidity, quality of life was assessed, and oncological outcomes were analyzed.

Results. One year later, the best results in terms of preserving erectile function were obtained in the group of patients who underwent bilateral nerve-sparing prostatectomy, and in the group without nerve-sparing, the most serious decrease in the level of erection was noted; prostatectomy with unilateral nerve-sparing took an intermediate value. Indicators such as overall satisfaction and quality of life were higher in patients of the nerve-sparing group compared with patients without nerve-sparing. All three types of radical prostatectomy, when strictly indicated, provide similar short-term oncological results.

Conclusion. Intrafascial unilateral nerve-sparing method is indicated for men with a low/intermediate risk of disease progression, both with and without preoperative erectile dysfunction, as it provides similar short-term oncological results and contributes to the restoration of a higher quality of life compared to traditional laparoscopic prostatectomy. The technique with bilateral preservation of intrafascial nerves promotes more effective preservation of erectile function in the postoperative period and can be recommended for young people with a high expectation of preservation of erectile function in the postoperative period.

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