Wide excision radical prostatectomy: Indications and surgical technique

Radical prostatectomy remains the gold standard for treatment of clinically localized prostate cancer. The goals of cancer control, preservation of urinary continence, and preservation of erectile function are of paramount importance whether the operation is performed via an open approach or with laparoscopic or robotic assistance. Careful examination of pelvic anatomy at the time of surgery should influence modification of surgical technique to the particular anatomy of the individual patient. The location, size, and extent of tumor as well as the course of the NVBs are important factors to consider when making the decision to perform wide excision. Positive surgical margins can be reduced by providing adequate exposure and hemostasis, by performing the appropriate extent of NVB preservation, and by wide dissection, including Denonvilliers' fascia, lateral pedicles, and bladder neck. It is only with careful attention to detail and meticulous surgical technique that we will maximize the likelihood of achieving optimal clinical outcomes for our patients.