Open Access

ARTICLE

Simple prostatectomy followed by radiation therapy for prostate cancer: a novel treatment pathway for men with marked prostatomegaly and prostate cancer: a series of cases

Tara Morgan^1,*, Brian Calio¹, Rafael Tua Caraccia¹, Daniel Segal², Joshua Kim³, Sarah Attia⁴, Neil B. Desai⁵, Jeffery Gahan¹

1 Department of Urology, Duke University Hospital, Durham, NC 27710, USA
2 Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
3 School of Medicine, Duke University, Durham, NC 27710, USA
4 School of Medicine, University of Texas Southwestern, Dallas, TX 75390, USA
5 Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA

* Corresponding Author: Tara Morgan. Email:

Canadian Journal of Urology 2025, 32(4), 309-315. https://doi.org/10.32604/cju.2025.063408

Received 14 January 2025; Accepted 09 June 2025; Issue published 29 August 2025

Abstract

Background: Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer (PCa) in those with concurrent significant lower urinary tract symptoms (LUTS). For men who meet this description with marked prostatomegaly, we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy (RASP) followed by external beam radiation therapy (EBRT) for the treatment of clinically significant prostate cancer. Methods: A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023. Demographic, peri-operative, and post-radiation treatment functional outcomes are reported. Results: No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months. The median time from RASP to EBRT was 9 months. Median prostate size was 135 g (IQR 110–165). 13 (76.5%) patients received a pre-EBRT rectal spacer. Median IPSS score preoperatively improved at 90 days post-RASP (13.5 vs. 2.5; IQR 10.8–15.2), and this benefit was sustained post-EBRT with a median IPSS at 3 vs. 12 months (4 vs. 0; IQR 0–5). There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3 (p = 0.677) or 12 (p = 0.627) months. In all 14 patients with localized disease and PSA data, none had recurrence during the study period. Conclusions: A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS. We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy. We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.

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