Prostate Cancer | Prof. Ye Dingwei (Urology) | CMCS Shanghai

About Prof. Ye Dingwei

Prof. Ye Dingwei is Chief of Urology at Fudan University Shanghai Cancer Center. He specializes in the diagnosis and surgical treatment of urological cancers, particularly prostate, bladder, and kidney cancer. He is a national leader in robotic-assisted urological oncology surgery.

Case Overview

A 68-year-old man presented with a one-year history of voiding dysfunction and a three-month history of elevated PSA. Biopsy confirmed Gleason 4+5=9 prostate adenocarcinoma with extracapsular extension into the right seminal vesicle (cT3aN0M0) — classified as high-risk locally advanced disease. Following MDT discussion, the patient received three months of neoadjuvant androgen deprivation therapy combined with docetaxel chemotherapy, achieving PSA reduction to 1.8 ng/mL and tumor downstaging on MRI. Prof. Ye Dingwei's team at Fudan University Shanghai Cancer Center then performed da Vinci robotic-assisted radical prostatectomy with bilateral neurovascular bundle (NVB) preservation and intraoperative ICG fluorescence navigation. R0 resection was achieved; PSA was undetectable at one year; urinary continence was fully restored at one month; and erectile function recovered to near-baseline at three months.

Patient Background

• Age / Sex: 68-year-old male
• Chief Complaint: Voiding difficulty with urinary frequency and urgency for 1 year; elevated PSA discovered 3 months prior
• Medical History: Hypertension for 5 years (well-controlled on medication); no diabetes; no prior surgery
• Digital Rectal Exam (DRE): Hard nodule palpable in right prostatic lobe; median sulcus obliterated

Pre-operative Workup

Laboratory Results

• PSA: 28.5 ng/mL (elevated)
• f/t PSA ratio: 0.12
• Testosterone: 4.2 ng/mL

Imaging (Multiparametric MRI + PSMA PET-CT)

• MRI: Right peripheral zone mass with extracapsular extension into the right seminal vesicle (cT3a); left NVB involvement suspected
• PSMA PET-CT: High right prostatic uptake (SUVmax 15.6); bilateral obturator lymph nodes with borderline uptake (below definitive metastasis threshold); whole-body bone scan negative

Biopsy

• 12-core systematic biopsy: 6/6 right cores positive, 2/6 left cores positive
• Gleason Score: 4+5=9 (high-risk)
• Clinical Stage: cT3aN0M0 — high-risk locally advanced prostate cancer

MDT Discussion

• Radiology: Large tumor volume with confirmed extracapsular extension
• Medical Oncology: Recommended 3 months of neoadjuvant ADT + docetaxel to downstage and reduce positive margin risk
• Radiation Oncology: Adjuvant IMRT planned post-surgery
• Urology (Prof. Ye Dingwei): Good performance status; no distant metastases; proceed with neoadjuvant therapy followed by robotic radical prostatectomy with maximal functional preservation

Diagnosis & Surgical Strategy

Diagnosis: High-risk prostate cancer (post-neoadjuvant therapy); hypertension.

Procedure: Transperitoneal da Vinci robotic-assisted laparoscopic radical prostatectomy (RARP) with extended pelvic lymph node dissection, bilateral NVB preservation, and ICG fluorescence navigation.

Rationale

• Neoadjuvant Downstaging: After 3 months of ADT + docetaxel, PSA fell to 1.8 ng/mL; MRI showed reduced tumor volume and limited seminal vesicle involvement — creating conditions for R0 resection and NVB preservation that would not have been possible at initial presentation
• Robotic Advantage: The da Vinci system's 7× magnified 3D visualization and tremor-filtered articulating instruments provide superior precision in the confined male pelvis — critical for protecting the urethral sphincter and NVB during apical dissection
• Functional Preservation Intent: Preoperative IIEF-5 score of 18 (mild ED); patient expressed strong desire for functional preservation. Prof. Ye elected modified intrafascial technique for bilateral NVB preservation, with full preservation on the left and partial preservation on the right given tumor involvement

Key Technologies

• Intraoperative ICG Fluorescence Navigation: ICG injected prior to bladder neck division; real-time fluorescence delineated prostatic and seminal vesicle blood supply boundaries, guiding precise apical urethral transection with confirmed negative margins
• Modified Rocco Stitch: Posterior bladder neck reconstruction to accelerate urinary continence recovery

Operative Procedure

• Access & Position: Pneumoperitoneum established (12 mmHg); transperitoneal approach; 4 robotic arms + 1 assistant port; 30-degree Trendelenburg position
• Exploration: No peritoneal metastases; pelvic peritoneum incised; extended bilateral pelvic lymph node dissection performed along iliac vessels; intraoperative frozen section — negative (0/12 nodes)

Prostate Dissection — Key Steps

• Dorsal Vein Complex (DVC): "Suture-first, cut-second" technique at the prostatic apex; minimal blood loss
• NVB Preservation:
  • Right side: Partial NVB preservation only — tumor involvement required sacrifice of lateral fascial layer; medial nerve fibers retained where oncologically safe
  • Left side: Complete intrafascial "cold dissection" technique — no electrocautery within 5 mm of nerve bundle; full NVB preserved
• ICG Fluorescence Navigation: Following IV ICG injection, fluorescence imaging confirmed prostatic apical blood supply boundaries; urethral transection performed under fluorescence guidance to ensure negative apical margin without sphincter injury

Specimen Retrieval & Reconstruction

• Prostate and seminal vesicles placed in retrieval bag; extracted via umbilical port
• Vesicourethral anastomosis: continuous running suture with posterior Rocco reconstruction; tension-free apposition
• F18 Foley catheter placed; single pelvic drain

Operative Data

• Operative Time: 150 minutes (including lymph node dissection)
• Estimated Blood Loss: ~80 mL (near-bloodless)
• Drain Output Day 1: <50 mL (serosanguineous)

Pathology & Post-operative Recovery

Pathology Report

• Gross: Prostate 4 × 3 × 3 cm; grey-white, firm cut surface
• Histology: Prostatic adenocarcinoma, Gleason 4+5=9
• Margins: Basal and apical margins negative — R0 resection confirmed
• Pathological Stage: pT3a (extracapsular extension); lymph nodes 0/12

Post-operative Course (ERAS Protocol)

• Day 0: Ambulating at 6 hours post-op; liquid diet commenced same day
• Continence Recovery: Catheter removed at 1 week; immediate continence rate (0–1 pad/day) 80%; complete continence achieved at 1 month
• Erectile Function: IIEF-5 score recovered to 16 at 3 months (near-baseline of 18); satisfactory sexual activity resumed — attributed to bilateral NVB preservation
• Adjuvant Therapy: Adjuvant IMRT commenced at 6 weeks post-surgery; continued androgen deprivation therapy (goserelin + bicalutamide)

Follow-up & Precision Medicine

• Germline Genetic Testing: Surgical specimen tested for homologous recombination repair (HRR) gene panel — BRCA2 germline pathogenic variant identified
• Precision Treatment Planning: Based on BRCA2 mutation status, Prof. Ye advised that if disease progresses to metastatic castration-resistant prostate cancer (mCRPC), PARP inhibitor therapy (e.g., olaparib) should be prioritized as first-line systemic treatment
• 1 Year Post-op: PSA <0.01 ng/mL (biochemical cure); no radiological recurrence

Expert Commentary — Prof. Ye Dingwei

1. Neoadjuvant Therapy as a Surgical Enabler

For Gleason 9 high-risk prostate cancer, proceeding directly to surgery without neoadjuvant treatment carries a positive margin rate that is simply unacceptable. The three months of ADT plus docetaxel in this case did not merely shrink the tumor — they transformed the surgical landscape. A seminal vesicle that was previously invaded became resectable with clear margins. A neurovascular bundle that would have been sacrificed became preservable. Neoadjuvant therapy, when guided by MDT and timed correctly, is not a delay to surgery — it is the surgery's foundation.

2. Robotic Precision in the Confined Male Pelvis

The male pelvis is an unforgiving operative environment. The prostatic apex, the dorsal vein complex, and the neurovascular bundles are separated by millimeters in a space that traditional laparoscopy struggles to navigate. The da Vinci system's 7× magnified three-dimensional visualization and tremor-filtered articulation allow a level of anatomical discrimination that is simply not achievable with conventional instruments. An estimated blood loss of 80 mL in a radical prostatectomy following neoadjuvant chemotherapy — which increases tissue fibrosis — reflects the precision that robotic surgery makes possible.

3. Functional Oncology — Cure and Quality of Life Are Not Mutually Exclusive

The traditional view that high-risk prostate cancer demands aggressive resection at the expense of function is outdated. With ICG fluorescence confirming apical margins in real time, and intrafascial cold dissection preserving the left NVB, this patient achieved R0 resection, undetectable PSA at one year, full urinary continence at one month, and near-baseline erectile function at three months. These are not competing outcomes — they are complementary ones. Functional urology is not a compromise of oncological surgery. It is its highest expression.

4. Precision Medicine Beyond the Operating Room

Removing the prostate is one chapter of this patient's story. The identification of a BRCA2 germline mutation transforms the entire subsequent treatment algorithm — not only for this patient, but potentially for his family members who may carry the same variant. At Fudan University Shanghai Cancer Center, we treat the tumor and the genome. That is what a national cancer center is for.

How CMCS Shanghai Coordinated This Case

China Medical Concierge Shanghai (CMCS) supported this patient's care pathway from initial overseas inquiry through one-year follow-up. Our coordination included:

• Pre-arrival PSA panel, biopsy report review, and specialist referral to Prof. Ye Dingwei's urology team at Fudan University Shanghai Cancer Center
• Arrangement of multiparametric MRI, PSMA PET-CT, and systematic biopsy at the Cancer Center
• Bilingual interpretation during MDT discussion and neoadjuvant treatment planning
• Coordination of three-month neoadjuvant therapy monitoring, including PSA trending and interim MRI scheduling
• Surgical admission logistics, including hospital registration and accommodation support for accompanying family
• On-site medical interpretation throughout the hospitalization and ERAS recovery period
• Post-discharge coordination of adjuvant IMRT scheduling, germline genetic testing, and PSA surveillance at 3, 6, and 12 months

For international patients facing a high-risk prostate cancer diagnosis, the complexity of neoadjuvant sequencing, robotic surgery, and precision medicine follow-up can be overwhelming. CMCS exists to manage that complexity — ensuring patients access China's leading urological oncology expertise with every step coordinated, every result explained, and every decision supported.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.