Cancer of Prostate
Conditions
Keywords
3D AI-AR-RARP, Cancer of Prostate, prostate surgery, Hyper-Accuracy 3D reconstruction (HA3DTM), Riders, computer vision, Robot-assisted, laparoscopic radical prostatectomy
Brief summary
This is a prospective randomized multicenter study aimed at comparing 3D AI-AR-RARP vs. no 3D, verifying the impact of this new technology on oncological and functional outcomes after the procedure.
Detailed description
Considering that prostate cancer lesions are not identifiable during surgery, except in the case of extensive and advanced tumors, the surgeon does not have a real-time perception of the location of the tumor. The absence of clear spatial visualization can therefore lead to a positive surgical margin, particularly in tumors in the T3 stage (invasion of the prostatic capsule or seminal vesicles). Our hypothesis is that with the help of AI 3D AR during surgery, positive surgical margins can be avoided, or at least reduced, while preserving the neurovascular bundles, with a consequent improvement not only in postoperative functional outcomes (continence and potency), but also oncological ones (less biochemical disease recovery (BCR), less need for salvage radiotherapy, lower risk of metastasis).
Interventions
PROCEDURE3D Robot-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy
The operation is performed using the Da Vinci HD robotic system which allows the use of laparoscopic instruments, with greater mobility and the possibility of easier and more precise control of movements in three dimensions. Furthermore, the system allows the surgeon a three-dimensional view of the operating field. The surgery is performed under general anesthesia. Six or more trocars are positioned, into which the instruments operated by the robot or directly by the surgical assistants are inserted. Then a radical prostatectomy is performed.
Sponsors
San Luigi Gonzaga Hospital
Fondazione del Piemonte per l'Oncologia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Patients will be randomized using an Excel® macro in 2 group: 3D and no3D, stratifying them by age, PSA, cT, PSA density, prostate volume, lesion volume, extracapsular extension (ECE), seminal vesicle invasion (SVI), biopsy ISUP.
Eligibility
Sex/Gender
MALE
Age
40 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
1. Signature of the written informed consent and consent to the use of personal data 2. Age \> 40 years and male sex 3. Pre-operative MRI performed according to ESUR recommendations and reporting in accordance with PiRads V.2 4. Disease with evidence of bulging or radiological T3 on pre-operative MRI 5. Histological diagnosis of acinar type prostate cancer in the area highlighted on MRI 6. Absence of bulky (\>3 cm), bony or visceral retroperitoneal or pelvic lymph node metastatic lesions 7. Patients eligible for radical prostatectomy + pelvic lymphadenectomy 8. ECOG PS 0-1 9. Life expectancy ≥ 5 years 10. Patients motivated to preserve erection and with pre-operative sexual activity with IIEF \>17 11. Availability of the patient's pre-operative clinical data 12. Patients must be available to carry out the visits foreseen in the follow-up of the protocol and consent to data collection
Exclusion criteria
1. Special histotypes of prostate cancer 2. Patients with PSA \> 100 ng/ml at diagnosis 3. Inability to perform MRI (pacemaker wearers, claustrophobia...) or MRI of inadequate quality to obtain the HA3DTM 3D reconstruction 4. Concomitant treatment with other antineoplastic drugs including investigational endocrine therapies 5. Serious uncontrolled concomitant medical condition or disease including active, uncontrolled infections 6. Patients with dementia or psychiatric illness that limit compliance with study requirements or that may prevent understanding and/or signing informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative surgical oncological outcomes | 12 months after surgery | Verify oncological outcomes in prostate cancer patients with evidence of bulging or extracapsular disease (ECE or rT3) on preoperative MRI, in terms of positive margin rate (PSM) following surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oncological outcomes | 5 years after surgery | Evaluation of patients' oncological outcomes during the follow up in terms of biochemical recurrence (BCR) and occurrence of local/distant recurrence detected with different imaging techniques during the FU according to clinical indication |
| Micturition outcomes | 5 years after surgery | Evaluation of continence recovery rate. Continence was defined as use of 0-1 pads/die. Furthermore 24/h pad test was performed in case of persistence of incontinence to evaluate the different degree of urine losses, and was classified according to ICS definitions. |
| Sexual function outcomes | 5 years after surgery | Evaluation of erection recovery in terms of IIEF-5 (International Index of Erectile Function Questionnaire). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Verify the potential application of AI | 12 months after surgery | Verify the potential application of AI as an alert system during surgery in order to reduce the rate of possible intraoperative complications |
Countries
Italy
Contacts
Primary ContactEnrico Checcucci, MD
Backup ContactMarco Asioli
Outcome results
None listed