Paediatric Surgery (Ukraine). 2025. 3(88): 87-94. doi: 10.15574/PS.2025.3(88).8794
Nakonechnyi Y. A., Mytsyk Yu. O., Nakonechnyi A. Y., Borzhievskyi A. Ts.
SNPE «Danylo Halytskyi Lviv National Medical University», Ukraine

For citation: Nakonechnyi YA, Mytsyk YuO, Nakonechnyi AY, Borzhievskyi ATs. (2025). Personalized preservation extraperitoneoscopic radical prostatectomy in high-risk prostate cancer patients. Paediatric Surgery (Ukraine). 3(88): 87-94. doi: 10.15574/PS.2025.3(88).8794.
Article received: Apr 26, 2025. Accepted for publication: Sep 16, 2025.

Radical prostatectomy (RP) remains one of the most common treatment approaches for localized prostate cancer (PCa). In recent years, it has been increasingly utilized in cases of high-risk prostate cancer (HR-PCa), where achieving an optimal balance between oncological control and functional outcomes is essential.
Aim – to describe and assess the safety and feasibility of personalized preservation extraperitoneoscopic radical prostatectomy (PP-ERP) in patients with HR-PCa.
Materials and methods. PP-ERP was performed in 21 well-informed HR-PCa patients. All patients underwent meticulous preoperative planning based on multiparametric magnetic resonance imaging with a picture quality score ≥4, utilizing 3D modeling. Imaging was interpreted by an experienced, sub-specialized radiologist. The PRECE nomogram was also utilized for surgical planning and for shared decision-making with the patient regarding the extent of tissue preservation. Urinary continence (UC), erectile function (EF), and biochemical recurrence (BCR) were assessed during the follow-up period.
Results. Using the described approach, extraprostatic extension (EPE) was accurately identified preoperatively in 95.2% of cases. At 12 months postoperatively, UC and EF were preserved in 95.2% and 61.9% of patients, respectively, according to the established criteria. Positive surgical margins were observed in 23.8% of cases, and BCR occurred in 19% at 24 months.
Conclusions. PP-ERP with precise surgical planning appears to be a safe and feasible approach for selected HR-PCa patients, offering encouraging functional and oncological outcomes.
This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution. The informed consent was obtained from all patients.
The author declares no conflict of interest.
Keywords: radical prostatectomy, personalized preservation, prostate cancer.

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