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PubMed2006

Laparoscopic and robotic radical prostatectomy.

Radical retropubic prostatectomy is the current gold standard for surgical removal of the prostate gland. Recently, laparoscopic radical prostatectomy has been developed in an attempt to decrease surgical morbidity, and the technical difficulty of laparoscopy has been countered with the development of the da Vinci robotic interface. Studies that have compared the minimally invasive approaches with the traditional open approach have reported comparable perioperative outcomes. While long-term oncological data are available for open prostatectomy, there are only short-term studies available for laparoscopic prostatectomy. Functional outcomes, including urinary continence and sexual function, appear to be similar between the surgical approaches in the short term. However, currently, costs appear to favor open surgery, with the da Vinci-assisted prostatectomy having the highest expenses. Longer-term data are required to confidently determine the optimal balance between morbidity, oncological efficacy, functional outcomes and cost among the differing surgical approaches.

Erectile Dysfunction↗

PubMed2005

[Pathophysiology and rehabilitation of erectile dysfunction after nerve-sparing radical prostatectomy].

Radical prostatectomy is the current standard procedure for locally confined prostate cancer and accounts for the largest portion of invasive therapies. However, a major drawback of this approach remains the frequently ensuing postoperative erectile dysfunction. This aspect represents a frequent cause of fear and concern both for the patients and their partners and has a significant impact on the choice of therapy.After bilateral sparing of the neurovascular bundles, an average of 50% of the patients is likely to complain of erectile dysfunction. It is only in the course of the first 2 years after prostatectomy that rehabilitation of erectile dysfunction can be expected. It is all the more crucial to begin with rehabilitation therapy of the erectile tissue at an early postoperative stage to the prevent an irretrievable loss of erectile function. Application of PDE-5 inhibitors as well as prostaglandins, phentolamine, or papaverine can help to induce and to support penile blood perfusion and oxygenation, thus preserving structure and function of the corpora cavernosa. All efforts must be directed towards keeping the erectile function at the level ascertained prior to the intervention.

Clinical Trials as Topic↗

PubMed1997

[Localized prostatic adenocarcinoma: role of pelvic radiotherapy following radical prostatectomy].

Radical prostatectomy after pelvic lymphadenectomy is an effective treatment for patients with T1-2 pN0 adenocarcinoma of the prostate. However, pathologic analysis of resected tissue reveals that in 20 to 40% of clinical stage B lesions, the tumour has extended locally beyond the prostate. This infra-clinical disease may be the origin of local relapse. Radiation oncologists are often asked to deliver post-operative irradiation. There is sufficient evidence in the literature that postoperative radiation therapy can improve local control rate for patients with pT3 pN0 adenocarcinoma of the prostate; however, the effect of this radiotherapy on survival in this category of patients remains unclear. It is the reason why randomised clinical trials have been implemented for investigating the role of pelvic external irradiation with respect to the effects on local control, acute and late morbidity, overall survival and cancer-related survival, and for better defining the selective indications of radiotherapy, regarding pathological data.

Adenocarcinoma↗

PubMed1994

[Role of biological and anatomo-pathologic criteria in the prognosis evaluation of patients before and after radical prostatectomy].

Radical prostatectomy is the treatment of choice for organ-confined prostatic cancers (T1-T2). However, it has been reported to improve the long-term survival of patients and achieve its oncological objectives in only one half of patients despite a serious morbidity. Based on a consecutive series of one hundred patients, the authors performed univariate statistical analysis to determine the predictive value of eight preoperative criteria for biological progression and capsular effraction: clinical stage, PSA (using a highly sensitive test derived from the Yang Proscheck and lowering the limit of detection to 0.1 ng/ml), PSA density (PSAD), percentage and topography of positive biopsies, capsular effraction, perineural spaces and Gleason's score. The predictive value for progression of five postoperative histological criteria (Gleason's score, capsule, perineural spaces, seminal vesicles and resection margins) was also studied in the same group of patients. The presence of capsular effraction on the biopsy was shown to have a positive predictive value of 90%. The three preoperative criteria most closely correlated with tumour progression were PSA, PSAD and percentage of positive biopsies (p < 0.001). Analysis of the combined predictive value of PSAD, percentage of positive biopsies and capsular effraction revealed that progression was always present when two of these criteria were positive. Seminal vesicle invasion on the operative specimen is the most pejorative element for progression. In conclusion, analysis of the histological features of biopsies associated with PSA and PSAD allows a more accurate selection of patients with a high risk of progression and seminal vesicle invasion is so pejorative that it could be detected in subjects with a preoperative PSA greater than 25 ng/ml.

Adult↗

PubMed1994

[Functional results and oncologic control after anatomic radical prostatectomy].

Radical prostatectomy is the gold standard-treatment for localized prostatic cancer. Recent technical advances allow a major decrease in morbidity without compromising cancer control. An improvement in patient selection is mandatory to provide opportunities to cure what has recently become commonest malignancy in men. This progress may also help to clarify the therapeutic strategy.

Adenocarcinoma↗

PubMed1995

Randomized prospective study comparing radical prostatectomy alone versus radical prostatectomy preceded by androgen blockade in clinical stage B2 (T2bNxM0) prostate cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study Group.

PURPOSE: Nonrandomized clinical trials have suggested that preoperative androgen deprivation can decrease the likelihood of positive surgical margins in patients with clinically localized prostate cancer. A multicenter prospective randomized trial compared radical prostatectomy alone to radical prostatectomy after 3 months of leuprolide acetate depot and flutamide in patients with stage cT2bNxM0 prostate cancer and a serum prostate specific antigen level less than 50 ng./ml. MATERIALS AND METHODS: We randomized 149 patients to undergo androgen deprivation and 138 to undergo lymphadenectomy with (137) or without (1) prostatectomy. Of the 154 patients randomized to the surgery alone group 144 underwent pelvic node dissection with (138) or without (6) prostatectomy. RESULTS: There was no statistically significant difference between the 2 groups in operating time, blood loss, need for transfusion, postoperative morbidity or length of hospital stay. There were 4 rectal and 2 ureteral injuries in the surgery alone group and none in the pretreatment group (p < 0.05). Patients who received androgen deprivation preoperatively had a significantly lower rate of capsule penetration (47% versus 78%, p < 0.001), positive surgical margins (18% versus 48%, p < 0.001) and tumor at the urethral margin (6% versus 17%, p < 0.01). CONCLUSIONS: Long-term followup data will be needed to determine whether there will be a lower incidence of biochemical relapse as determined by prostate specific antigen, local recurrence or metastasis, with an improvement in patient survival.

Aged↗

PubMed2005

Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain.

PURPOSE: Laparoscopic prostatectomy, whether or not coupled with robotic assistance, is often considered less invasive than open radical retropubic prostatectomy (RRP). Minimal postoperative pain has been reported following robot assisted laparoscopic prostatectomy (RALP) but there have been few comparative studies with RRP. We compared perioperative narcotic use and patient reported pain in a prospective patient series. MATERIALS AND METHODS: Between June 2003 and May 2004, 314 patients underwent radical prostatectomy at our institution, including RALP in 159, RRP in 154 and conversion in 1. All patients were treated on a postoperative clinical pathway that included 30 mg ketorolac intravenously immediately postoperatively, followed by 15 mg intravenously every 6 hours. No regional anesthesia (epidural/spinal) narcotics or patient controlled analgesic pumps were used. All narcotic use was converted to morphine sulfate equivalents for purpose of analysis. A Likert scale of 0 to 10 was used to assess pain on the day of surgery, and on postoperative days 1 and 14. RESULTS: The total mean morphine sulfate equivalent +/- SD in patients in the RALP and RRP groups was low and, when corrected for length of stay, it was not statistically different (22.41 +/- 1.13 vs 23.01 +/- 1.16 mg, p = 0.72). Mean Likert pain perception scores were low at all time points in the RALP and RRP groups but statistically lower on the day of surgery in the RALP cohort (2.05 +/- 1.99 vs 2.60 +/- 2.25, p = 0.027). Patient reported mean pain scores were almost identical for RALP vs RRP on postoperative days 1 (1.76 +/- 1.87 vs 1.73 +/- 1.77, p = 0.880) and 14 (2.51 +/- 1.91 vs 2.42 +/- 1.84, p = 0.722). CONCLUSIONS: Perioperative narcotic use and patient reported pain are low regardless of the surgical approach used for radical prostatectomy. RALP did not provide a clinically meaningful decrease in pain compared with RRP, primarily because of the low pain scores reported in each group. Outcomes other than pain will ultimately determine the role of laparoscopic radical prostatectomy and RALP.

Aged↗

PubMed2006

Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy.

OBJECTIVES: To compare intraoperative blood loss, perioperative hematocrit, and transfusion requirements in patients undergoing radical retropubic prostatectomy (RRP) versus robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon. METHODS: During a 14-month period, 279 patients with localized carcinoma of the prostate were prospectively enrolled in this comparative study. The decision of which surgical approach to use was by patient choice. Of the 279 patients, 176 underwent RALP and 103 underwent RRP. The serum hematocrit was obtained preoperatively and 24 hours postoperatively in all patients. The intraoperative blood loss was recorded, and transfusion requirements were noted. RESULTS: Patients in the RALP group had significantly less intraoperative blood loss compared with the RRP group (mean 191 mL versus 664 mL, P < 0.001). Additionally, the difference in the discharge hematocrit (36.8% versus 32.8%, P < 0.001) and the mean perioperative change in hematocrit (8.0% decrease versus 10.7% decrease, P < 0.001) were significant between the RALP and RRP groups, respectively. Three patients in the RRP group (2.9%) and one in the RALP group (0.5%) required transfusion of blood products (P = 0.14). CONCLUSIONS: The results of this study have shown that RALP is associated with less intraoperative bleeding than RRP, and patients undergoing RALP have a greater serum hematocrit at hospital discharge. The lack of a statistically significant difference in blood transfusion was partially attributable to the low transfusion rate in both groups in this series.

Blood Loss, Surgical↗

PubMed2000

Efficacy of sildenafil in erectile dysfunction after radical prostatectomy.

Radical retropubic prostatectomy (RRP) is an important cause of iatrogenic erectile dysfunction (ED). While sildenafil has been widely used since its introduction as a new treatment option for ED, its efficacy in post-RRP patients has not been extensively studied. We retrospectively compared the efficacy of sildenafil in post-RRP and non-surgical patients with ED (NSED) using a subset of questions from the International Index of Erectile Function (IIEF) and correlated results with their specific etiology of ED based on penile blood flow study (PBFS). A brief questionnaire regarding satisfaction with sildenafil was administered to 72 consecutive post-RRP patients (nerve sparing status unknown) and 32 consecutive NSED patients who had previously undergone PBFS with pharmacotesting as part of their evaluation for ED. PBFS diagnoses were arterial insufficiency (AI) for peak systolic velocity (PSV) < 25 cm/sec; venogenic (CVOD) for PSV > or = 35 cm/sec, mixed vascular for PV > 25 but < 35 cm/sec and resistive index (RI) < 0.9; a vascular normal diagnosis (neurogenic impotence) required excellent rigidity sustained for 20 min. Differences in the IIEF subscores for the different groups of patients were assessed. Success with sildenafil was defined as moderate or excellent improvement (3/4 or 4/4) with ability for penetration. No differences were found among the different subgroups of RRP patients with respect to IIEF scores or success rates with sildenafil. NSED patients had both significantly higher post-treatment IIEF scores (3.6/3.4 vs 2.5/2.2; t=4.50, P<0.0001) and success rates (63% vs 31%; t=3.11, P < 0.01) with sildenafil treatment than RRP patients. We found that sildenafil is significantly less effective in impotent RRP patients than in age-matched patients with ED (31% vs 63%). We had postulated that sildenafil would be least effective among RRP patients with excellent sustained rigidity to PGE1, as this subgroup is likely to have neurogenic impotence. We found that sildenafil response rates among subgroups of RRP patients were statistically similar regardless of PBFS diagnosis. IIEF scores for the RRP subgroups were similar but statistically lower than in men with ED and no history of RRP. While individuals with normal vascular responses to PGE1 have an increased likelihood of having neurogenic impotence, in RRP patients, we were unable to demonstrate any difference in efficacy of sildenafil, regardless of the PBFS diagnosis.

Aged↗

PubMed1995

Cost-efficient radical prostatectomy.

Radical retropubic prostatectomy is an easily standardized procedure with reproducible outcomes. Care has been standardized at our institution through the use of a collaborative care approach that defines the optimal care and outcomes for the ideal patient on a daily basis. This approach is based on an objective evaluation of the available medical literature. With this program, hospital charges have been reduced by 41% and hospital stay has been reduced to 2.9 days. Surgical outcomes have been excellent with low morbidity rates and excellent patient acceptance. Collaborative care programs for health care provide a comprehensive approach that allows for the delivery of cost-efficient care, which is supportive of the patient and allows continual refinement in care based on objective analysis of outcomes.

Cost Control↗

PubMed1995

[Extra-aponeurotic traditional radical prostatectomy].

Radical extra-aponeurotic prostatectomy is the surgical procedure which guarantees the best chances of total cancer ablation when the lesion is localized. Our incidence of positive specimen margins is low (4.6%). In our experience total incontinence occurs in 3 patients (3.5%). A low rate of post-operative complications makes this operation relatively safe and well accepted by patients. From our data "Nerve Sparing" prostatectomy must be reserved to selected cases in well motivated patients, because with this procedure the risk of oncological failure remains high.

Follow-Up Studies↗

PubMed2005

Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy verus open retropubic radical prostatectomy.

OBJECTIVE: Morbidity and postoperative pain after extraperitoneal (E-LRPE) and transperitoneal (T-LRPE) laparoscopic radical prostatectomy was compared to open extraperitoneal radical prostatectomy (O-RPE). MATERIAL AND METHODS: Between January 2002 and October 2003, we evaluated 41 E-LRPE, 39 T-LRPE and 41 O-RPE prospectively. All operations were performed as standard procedures by the same group of surgeons and perioperative results and complications were evaluated. Pain management was performed with tramadol 50-100 mg on demand, and no other form of anaesthesia was given. Postoperative pain was assessed daily in all patients quantifying analgesic requirement and evaluation of Visual Analogue Scale (VAS). All patients had at least a 12 month follow-up. RESULTS: Mean age, prostate volume, PSA and Gleason score were comparable between all three groups (p>0.05). Mean blood loss was lower with laparoscopy (189+/-140 and 290+/-254 ml), as compared to 385+/-410 ml for O-RPE (p=0.002). However, mean operating times were significantly longer in L-TRPE (279+/-70 min) as compared to E-LRPE (217+/-51 min) and O-RPE (195+/-72 min) (p<0.001), but E-LRPE and O-RPE showed no statistical difference (p=0.1143). Average VAS score on the 1st and 5th postoperative day for E-LRPE versus T-LRPE versus O-RPE was 4.9+/-1.0 versus 7.8+/-1.5 versus 5.8+/-1.9 and 1.6+/-0.9 versus 2.3+/-1.2 versus 2.3+/-0.9 respectively, which was significant lower (p=0.02) between E-LRPE versus T-LRPE (p<0.001) and O-RPE (p=0.008), but equal (p=0.655) between T-LRPE and O-RPE since postoperative day 3. Mean tramadol analgesic consumption within the first postoperative week was 290 versus 490 versus 300 mg respectively, which was statistical different between E-LRPE and T-LRPE (p<0.001), O-RPE and T-LRPE (p<0.001), but not between E-LRPE and O-RPE (p=0.550). Statistical analysis revealed a strong correlation of urinary leakage with increased postoperative pain (p=0.029) in all groups, especially for T-LRPE (p=0.007). Likewise, increased operating times (>240 min) were associated with increased post-operative pain (p=0.049). Full continence defined as no pads at one year was achieved in 36/41 (88%, E-LRPE) versus 33/39 (85%, T-LRPE) versus 33/41 (81%, O-RPE), respectively (p=0.2). CONCLUSION: E-LRPE resulted in a significant subjective (VAS Score, p<0.001) and objective (analgetic consumption, p<0.001) pain reduction compared to T-LRPE, but only in VAS Score compared to O-RPE (p=0.008). Analgetic consumption during first postoperative week was equal in E-LRPE (290 mg) and O-RPE (300 mg) (p=0.550). Shorter operating times, lower urinary leakage rates, lower stricture rates and lower blood loss in E-LRPE compared to T-LRPE are mainly explained due to the long learning curve in LRPE, which we did not overcome yet, and not due to the approach (extraperitoneal versus transperitoneal).

Adenocarcinoma↗

PubMed2003

Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy.

OBJECTIVE: To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period. PATIENTS AND METHODS: The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy (RRP) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy (LRP). The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score. The peri-operative data included operative time, intra-operative and post-operative transfusion rates, complication rates, hospitalization length, and duration of catheterization. The following pathological parameters were considered: Gleason score, pathological stage, and positive surgical margin rate. A comparative evaluation of continence recovery (no pads and any leakage) was made only in patients with follow-up longer than 12 months. RESULTS: The two groups were comparable in terms of pathological stage and definitive Gleason score. Operating times were significantly shorter in RRP (p<0.0001). LRP patients showed higher autologous (p<0.001) and eterologous transfusion (p=0.03). No significant difference was observed in terms of complication rates (p=0.07). The rectal injury rate was 2.8% in the laparoscopic group. The mean post-operative hospital stay was 10.2+/-2 days in the surgery group and 7.2+/-3.4 days in the laparoscopy group (p<0.001). Catheterization time was 8.4+/-0.9 days in the surgery group and 8+/-2.8 days in the laparoscopy group (p=0.27). After 12 months, complete continence was achieved in 64% of RRP and 40% of LRP patients, respectively (p=0.29). CONCLUSION: The results of our non-randomized study show that up to now laparoscopic radical prostatectomy does not provide significant advantages in terms of peri-operative morbidity compared with the traditional retropubic approach.

Aged↗

PubMed2003

Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy.

OBJECTIVES: To evaluate and compare prospectively the convalescence of patients after laparoscopic radical prostatectomy (LRP) and open radical retropubic prostatectomy (RRP) in a standardized clinical care pathway at a single institution by two surgeons of equal experience and training. METHODS: The study included all 60 patients undergoing LRP and RRP by two fellowship-trained surgeons in their first year of practice. The postoperative care of these patients was uniform and standardized. The medical records were reviewed and convalescence data obtained by an independent urologist and physician's assistant. RESULTS: Of the 60 patients, 24 underwent RRP and 36 underwent attempted LRP; 3 patients were converted from LRP to RRP. The differences in mean age, preoperative prostate-specific antigen level, Gleason score, in-hospital morphine equivalent requirement, time to oral intake, and hospital stay were not statistically significant between the LRP and RRP groups. The operating room time was significantly longer (5.8 +/- 1.2 hours versus 2.8 +/- 0.55 hours, P <0.0001) and the estimated blood loss was significantly lower in the LRP group (533 +/- 212 mL versus 1473 +/- 768 mL, P <0.0001) than in the RRP group. Pain medication use at home was significantly less in the LRP group (9 +/- 13 versus 17 +/- 15 oxycodone tablets, P <0.04), as was the time to complete convalescence (30 +/- 18 days versus 47 +/- 21 days, P <0.002). CONCLUSIONS: Although LRP took almost twice as long to complete as RRP in our initial clinical experience, the patients had a similar hospital course. LRP patients required less pain medication after discharge and had a shorter time to complete recovery than did RRP patients. Additional studies are needed to address long-term cancer control, potency, and continence outcomes to determine the precise role of LRP in the treatment of men with clinically localized prostate cancer.

Convalescence↗

PubMed1994

Radical prostatectomy and radical radiation therapy for clinical stages T1 to 2 adenocarcinoma of the prostate: new insights into outcome from repeat biopsy and prostate specific antigen followup.

Assessment of outcome following radical treatment for stages T1 to T2 prostate cancer has become more sensitive and rapid with the use of serum prostate specific antigen (PSA) in routine followup. PSA has identified substantially more failure following all radical therapies than was previously detected in series using clinical end points. Furthermore, it has also allowed a better assessment of the biological potential of histologically evident residual disease, that is a positive surgical margin after prostatectomy or positive repeat biopsy 2 years after radiation. Both situations are associated with subsequent biochemical failure in the majority of patients. The stages T1 to T2 cancer group is extremely heterogenous. In the few series with PSA followup that have evaluated long-term (greater than a decade) outcome for this group some report cure rates well below 40% for surgery and radiation. When comparing the results of any radical treatment series (surgery versus surgery and radiation versus radiation, as well as radiation versus surgery) selection may have a crucial role in predicting outcome. Surgical series tend to contain more patients with stages T1 to T2a tumors of low grade who have low initial PSA values and are known to have negative nodes. These patients, when treated with radical radiation, also have a favorable prognosis. It is hoped that the introduction of screening programs will improve outcome through earlier disease detection.

Adenocarcinoma↗

PubMed2004

[Adjuvant and salvage radiotherapy after radical prostatectomy].

Currently radical prostatectomy remains the standard mode of treatment for patients with locally and localized stage of prostate cancer. On the other hand, after radical prostatectomy approximately 50% of patients have postoperative positive margin. Therefore implementation of effective mode of adjuvant radiotherapy treatment after radical prostatectomy plays important role in clinic. Currently available data, which evaluated the effectiveness of radiotherapy after radical prostatectomy are based on retrospective studies. These studies indicated that post-operative radiotherapy reduced the local recurrence rate but the influence on the patient's survival is unknown. Generally, the following factors are considered as prognostic for failure: the presence of pathologic T3 (pT3), positive surgical margin, preoperative concentration of prostatic specific antigen (PSA) above 25ng/ml, metastases to lymph nodes, Gleason >7. Radiotherapy is performed as typical adjuvant radiotherapy in case of pT3 or positive margin without rising of PSA level. This mode of treatment is efficient and gives the excellent local control rate but without marked influence on overall survival of patients. Another strategy, which is considered after radical prostatectomy, is salvage radiotherapy. This mode of treatment is introduced when the rising level of PSA and/or the pathological recurrence mass in the tumor bed is occurred. The efficacy of the salvage radiotherapy is lower than classical adjuvant radiotherapy. Still remain questions about the following issues: timing of radiotherapy, optimal dose, treatment technique, involved target for radiotherapy, and the role of adjuvant hormonal therapy. The last issue now is evaluating in the randomized clinical trial. In summary, currently until outcomes from well conducted randomized trials will available patients after radical prostatectomy with adverse significant factors for local recurrence or/and increased level of PSA should be considered for postoperative radiotherapy.

Humans↗

PubMed2003

Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up.

OBJECTIVE: Laparoscopic radical prostatectomy is a complex procedure and has been standardized only during the last years. The remote controlled da Vinci Surgical System has opened up a new era in minimally invasive surgery. We here present our initial experience with the translation of open retropubic radical prostatectomy to laparoscopic technique using da Vinci and a one year follow-up. METHODS: After a period of technical development and training on cadavers, 40 consecutive patients eligible for radical prostatectomy were treated. After port placement, the urologist took control of the 3D 30 degrees laparoscope and the two instrument arms at the da Vinci remote console to perform bilateral pelvic lymph node dissection, radical prostatovesiculectomy and urethrovesical anastomosis. RESULTS: The procedure was completed laparoscopically in all but two patients. Mean procedure time was 8.3 hours and mean intra-operative blood loss 570 ml. Learning curves associated with the use of the da Vinci Surgical System show that there is a 22-minute decrease in time required to perform the radical prostatectomy and lymphadenectomy for each case (p<0.0001). Patients recovered rapidly after surgery with early oncological and functional results that were similar to those obtained with our standard radical prostatectomy technique. CONCLUSIONS: Remote controlled robotic surgical systems are useful to translate open retropubic radical prostatectomy to laparoscopy. This new technology has the potential to equip the urologist with the microsurgical precision needed to preserve the delicate structural integrity of the pelvic floor in order to improve functional results without compromising the oncological outcome.

Aged↗

PubMed1998

New indications for radical prostatectomy.

PURPOSE: Radical prostatectomy is considered the gold standard for treatment of localized prostate cancer, either as primary or salvage therapy. Recently with the advent of increased organ transplantation, use of prostatic specific antigen for cancer detection and cryoablation as an alternative treatment, more men with prostate cancer can be considered for radical surgery. We review these new indications. MATERIALS AND METHODS: Clinically localized untreated prostate cancers were identified in 3 men being considered for cardiac or lung transplantation (group 1), and 4 men originally treated with transperineal cryoablation had local relapse (group 2). All 7 men underwent radical prostatectomy. RESULTS: Organ confined cancer (pT2C) was found in all 3 patients in group 1. All 3 men underwent successful cardiac or lung transplantation 1 to 12 months after radical prostatectomy, and they are disease-free at short-term followup. Of the group 2 patients 2 had organ confined disease (pT2b and c) and 2 had extensive extraprostatic disease (pT3cN1 and pT3cN0). Only 2 patients remain disease-free and do not require adjuvant endocrine therapy. Major perioperative complications of rectotomy and total incontinence occurred only in group 2 patients. CONCLUSIONS: Patients being considered for heart and lung transplantation need to be free of concurrent malignancy because of immunosuppressive therapy. Radical prostatectomy can achieve this goal in select patients. Cases of failed cryoablation can be salvaged with radical prostatectomy but with less chance of success and with greater risk of complications.

Aged↗