Precision Imaging Enables Timely Treatment: Shanghai General Hospital South Campus Completes First Non-Biopsy Radical Prostatectomy

https://mp.weixin.qq.com/s/h6hCvvBHfosM_7d9Bk87UQ

Recently, the urology team led by Professor Xu Chuanliang at the South Campus of Shanghai General Hospital successfully performed the hospital’s first non-biopsy robot-assisted radical prostatectomy for prostate cancer. The breakthrough of this case lies in the shift from conventional diagnostic approaches to a non-invasive and highly precise diagnostic method, integrating MRI and PSMA-PET/CT imaging.

The patient, Mr. Liu (pseudonym), underwent examination at the South Campus, where imaging results revealed a significantly enlarged prostate with a prominently protruding middle lobe. Combined with abnormal increases in PSA (prostate-specific antigen) levels through dynamic monitoring, the medical team highly suspected localized prostate cancer. Given the high accuracy of the imaging-based diagnosis and the team’s extensive clinical experience, they determined that immediate radical surgery would be the optimal course of treatment.

Traditionally, prostate cancer diagnosis and treatment rely heavily on needle biopsy, which can cause significant psychological stress for patients and may lead to complications such as urinary incontinence, infection, and bleeding—adding to the patient's physical burden and prolonging the diagnostic process.

In this case, Professor Xu's team took an innovative approach, leveraging the combination of MRI and PSMA-PET/CT to conduct a non-invasive and precise assessment, thereby skipping the biopsy step. PSMA-PET/CT is a hybrid imaging modality that combines positron emission tomography (PET) and computed tomography (CT). Professor Xu explained: “This approach reduces invasive procedures and streamlines surgical planning, which helps avoid biopsy-related trauma and complications, enhances post-operative quality of life, saves medical resources, and lowers overall treatment costs—demonstrating the efficiency and cost-effectiveness of precision medicine.”

Based on precise preoperative imaging, the surgical team performed a transabdominal robot-assisted laparoscopic procedure. The operation lasted 120 minutes and resulted in the complete removal of the prostate and seminal vesicles. Despite the complex anatomy caused by the protruding middle lobe, the team precisely controlled intraoperative bleeding to just 100 ml, avoiding the need for blood transfusion, and carefully preserved the sphincter function. Urinary tract reconstruction was achieved via bladder neck-to-urethra anastomosis, laying the foundation for optimal postoperative urinary control.

Mr. Liu recovered quickly and was able to move independently on the same day of the surgery. Postoperative pathology confirmed the diagnosis of malignant prostate tumor without lymph node metastasis—completely consistent with the preoperative imaging findings. This validated the high accuracy of the MRI combined with PSMA-PET/CT in diagnosing prostate cancer.

The integration of MRI and PSMA-PET/CT significantly shortened the patient's diagnostic waiting time, allowed timely decision-making for treatment, and reduced both psychological and physical burdens. According to Professor Xu, the success of this case marks a transition in prostate cancer diagnosis and treatment—from the traditional model of “biopsy confirmation followed by staging and surgery” to a new paradigm of “direct surgical planning based on comprehensive imaging evaluation.”

Reporter: Li Tianwei

Images Courtesy of: Interviewed Department

Editors: Wang Hongxia, Gui Kexin

Reviewers: Zhou Yangbo, Li Yubo

Translated from: Shanghai Songjiang Wechat Official Page