Surgical Management of Prostate Cancer Recurrence in Residual Seminal Vesicle after Open Radical Prostatectomy

Abstract

Clinical History:

A 73-year-old male with a remote history of retropubic radical prostatectomy for prostate cancer of unknown pathology, presenting with rising PSA to 3.13.

Physical Exam:

Benign genitourinary exam with no prostate palpable upon digital rectal exam.

Diagnosis:

Localized recurrence of prostate cancer in the right residual seminal vesicle.

Intervention:

Robotic-assisted laparoscopic removal of bilateral seminal vesicles, metal clip placement at surgical margins, and right obturator and internal iliac lymph node dissection. Fluorescence-enhanced imaging with ICG was used throughout the dissection to visualize the ureters.

Follow-up/Outcome:

Patient was discharged in stable condition on postoperative day 2. The 6 week postoperative PSA was 0.62. The permanent pathology report was positive for a tumor at the lateral and bladder margins, consistent with metal clip placement. No identifiable lesion on the 3-month postoperative MRI, and salvage radiation with ADT was pursued.

Patient Consent Statement:

Michael E. DeBakey VA.

Author Disclosure Statement:

The authors have no conflicts of interest to disclose. Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Runtime of video: 4 mins 56 secs.