SEARCH · PubMed Health

Results for “Radical prostatectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMed2001

Prevention and management of incontinence following radical prostatectomy.

Incontinence after radical prostatectomy can have a significant impact on quality of life. Although several risk factors have been identified, the surgical technique and advancing age are important factors associated with postprostatectomy incontinence. Despite advances in technique, incontinence still occurs in a small group of men. Sphincteric dysfunction is the most common cause of postradical prostatectomy incontinence, but bladder dysfunction cannot be discounted. Treatments range from conservative to surgical and should be tailored to the individual based on the degree of bother and patient willingness to accept different therapeutic options.

Humans↗

PubMed1991

Male urethral sphincteric anatomy and radical prostatectomy.

Continence after radical prostatectomy is a multifactorial problem with no clear common denominator. At the heart of success is proper patient selection and operative skill in the precise dissection of the sphincteric anatomy. In general, surgeons who know the anatomy protect the patient by virtue of less blood loss, better margins of resection, and greater functional preservation.

History, 19th Century↗

PubMed2001

Neoadjuvant hormone therapy and radical prostatectomy: the jury is still out.

Radical prostatectomy may lead to cure as long as the cancer is confined to the prostate and all malignant cells are removed. However, clinical staging is inaccurate and a significant proportion of cT1-T2 patients have positive margins which increases the likelihood of disease progression within 5 years of surgery. Neoadjuvant hormone therapy is one option being used to increase the likelihood of prostate cancer cure after radical prostatectomy. Randomized clinical trials using neoadjuvant hormone therapy and radical prostatectomy have been conducted mainly in patients with cT1 and cT2 prostate cancer. A decrease in the number of positive surgical margins was found in cT1 and cT2 prostate cancer patients receiving neoadjuvant hormone therapy, with a further decrease in those receiving treatment over longer periods. In cT3 prostate cancer patients equivocal results have been obtained and further research is needed. None of the studies reported so far were able to define the impact of neoadjuvant treatment on the surgical management of locally advanced prostate cancer. Additional studies are required to determine the optimal type and duration of hormone treatment. Furthermore, long-term follow-up is needed to evaluate whether neoadjuvant therapy will improve overall survival. In the meantime, patients must be informed of the advantages and disadvantages of treatment to allow them to make informed treatment decisions.

Androgen Antagonists↗

PubMed2004

Transperitoneal laparoscopic radical prostatectomy: descending technique.

Laparoscopic radical prostatectomy has evolved over the last decade to become a common treatment for clinically localized prostate cancer at specialized institutions. During that time, various technical modifications have been pioneered by groups throughout the world. We present our technique of transperitoneal laparoscopic radical prostatectomy through a descending approach. We believe that the transperitoneal approach affords better visual landmarks, a larger operative space, and a stable pneumoperitoneum. Our technique employs a five-trocar approach to the prostate. All dissection and suturing is performed intracorporeally. The perioperative morbidity and short-term efficacy are similar to those of the open procedure.

Adult↗

PubMed2006

Robotic-assisted laparoscopic radical prostatectomy.

Robotic-assisted radical prostatectomy uses the newest technology for surgical treatment of men with prostate cancer. Cancer of the prostate is the most common cancer in men and the second leading cause of death in American men. The Benefits of robotic-assisted prostate surgery over open radical prostatectomy include small portal incisions, decreased blood loss, and shorter hospital stays. Magnification of the surgeon's field of vision and jointed laparoscopic instruments that mimic the human wrist allow precision of movement and the ability to spare nerves, which result in improved postoperative urinary continence and sexual function.

Humans↗

PubMed1999

Hormonal manipulation for rising PSA after radical prostatectomy.

PSA recurrence after radical prostatectomy usually indicates recurrent prostate cancer. Identification of the recurrence site is difficult, but pathological and clinical features may suggest local versus distant recurrence. Radiographic techniques including transrectal ultrasonography, and 111indium capromab pendetide scans may help identify recurrences. The use of hormonal manipulation for rising PSA after radical prostatectomy is controversial. Androgen deprivation has been a mainstay of the management for advanced prostate cancer. The timing of such therapy is debatable, and early therapy in an asymptomatic patient may not correlate with improved survival. Maximal androgenic blockade with castration and nonsteroidal antiandrogens may offer a modest survival benefit in selected patients. Novel potency-sparing therapies with antiandrogens and finasteride afford an improved patient lifestyle, with questionable effects on survival. Intermittent androgen suppression is an experimental treatment modality that may reduce the side effects of castration. Ongoing studies are being performed to clarify these controversies, and the variety of treatment options allows patients great flexibility in considering quality of life and effective cancer control.

Androgen Antagonists↗

PubMed2000

Laparoscopic radical prostatectomy: preliminary results.

BACKGROUND: Retropubic and perineal radical prostatectomy are used for curative treatment of localized prostate cancer. More complex urological procedures are now being done with laparoscopy. We present our initial results of transperitoneal laparoscopic radical prostatectomy. MATERIALS AND METHODS: Twenty laparoscopic radical prostatectomies were performed between May 1998 and May 1999. The mean age at the time of surgery was 64.2 years. There were 14 stage T1c, 5 stage T2a and 1 stage T2b tumors. The preoperative PSA was 9. 3 ng/ml (normal <4 ng/ml). The Gleason score for positive specimens in 6 random echo-guided endorectal biopsies was 5.7. Four trocars were used. Insufflation pressure was 15 mmHg. The seminal vesicles were first dissected. The prostate was dissected free from the anterior face of the rectum to the prostate apex. Then the peritoneum was incised to find the apex of the prostate. The puboprostatic ligaments were isolated and cut, and the dorsal vein complex was ligated and cut to expose the urethra. The bladder neck was opened and dissected free from the prostate. The lateral pedicles were coagulated before sectioning the urethra. The radical prostatectomy specimen was left along the sigmoid colon, the bladder neck was reconstructed, and a urethrovesical anastomosis was performed with 6 interrupted sutures. The prostatectomy specimen was removed intact in a sack by enlarging the umbilical trocar port. All the prostatectomy specimens were processed according to the Standford protocol. Prostate weight, tumor weight, the Gleason score, and the tumor status of the capsule, seminal vesicles, lymph nodes and surgical margins were studied. RESULTS: The operating time was 385 min. Two patients were transfused. The mean hospital stay was 7. 8 days. The Foley catheter was removed 10.7 days after the operation. Specimen weight was 61 (28-126) g, the Gleason score was 5.9, and tumor volume was 1.4 ml. There were 18 stage pT2, 1 stage pTa (capsular effraction) and 1 stage pT3b (seminal vesicle invasion) tumors. There were four positive surgical margins (2 at the apex and 2 at the bladder neck). All the patients had a postoperative PSA level <0.1 ng/ml at 1 month. The first patient had urethrovesical anastomotic leakage, and required Foley catheterization for 21 days. There was 1 colostomy for rectal injury and 1 urinoma because of urethrovesical anastomotic leakage that required an open surgical procedure. One month after surgery, 15 (75%) patients were fully continent. Six patients had erections, and 5 stated having sexual intercourse. CONCLUSION: These preliminary results show that radical prostatectomy can be performed laparoscopically. Laparoscopy offered excellent vision of all the anatomical structures of the pelvis, permitting precise dissection. Long-term follow-up and further studies are required to confirm and improve these results.

Aged↗

PubMed2005

[Evaluation of autologous transfusion for radical prostatectomy].

Forty-six radical prostatectomy patients in whom an autologous transfusion had been performed in our hospital were studied retrospectively. Preoperative autologous donation (PAD), erythropoietin (EPO) administration and acute normovolemic hemodilution (ANH) were used for autologous transfusion. Red blood cell volume lost during hospitalization was calculated as 1329 +/- 493 ml. Red blood cell volume saved by PAD and ANH were calculated as 470 +/- 33 ml and 301 +/- 90 ml, respectively. Three patients made use of allogeneic blood transfusion. Radical prostatectomy can be performed using PAD, EPO and ANH without allogeneic transfusion.

Aged↗

PubMed2002

Influence of biopsy perineural invasion on long-term biochemical disease-free survival after radical prostatectomy.

OBJECTIVES: To investigate the influence of biopsy perineural invasion (PNI) on long-term prostate-specific antigen recurrence rates, final pathologic stage, and surgical margin status of men treated with radical prostatectomy. Radical prostatectomy offers the best chance for surgical cure when performed for organ-confined disease. However, the histologic identification of PNI on prostate biopsy has been associated with a decreased likelihood of pathologically organ-confined disease. METHODS: Seventy-eight men with histologic evidence of PNI on biopsy underwent radical prostatectomy by a single surgeon between April 1984 and February 1995 and were compared with 78 contemporary matched (biopsy Gleason score, prostate-specific antigen level, clinical stage, age) controls without PNI. Biochemical disease-free survival and pathologic findings were compared. RESULTS: After a mean follow-up of 7.05 +/- 2.2 years and 7.88 +/- 2.7 years (P = 0.04) for patients with biopsy PNI and controls, respectively, no significant difference in the long-term prostate-specific antigen recurrence rates was observed (P = 0.13). The final Gleason score and pathologic staging were also similar in this matched cohort. Although the numbers of neurovascular bundles resected were comparable between the groups, no difference was found in the rate of positive surgical margins identified (13% versus 10%, P = 0.62). CONCLUSIONS: We were unable to show that PNI on needle biopsy influences long-term tumor-free survival.

Analysis of Variance↗

PubMed2006

Robotic extraperitoneal radical prostatectomy: an alternative approach.

PURPOSE: Laparoscopic radical prostatectomy with or without a robot has been increasingly performed worldwide, primarily using a transperitoneal approach. We report our experience with daVinci(R) robot assisted extraperitoneal laparoscopic radical prostatectomy. MATERIALS AND METHODS: A total of 325 patients underwent robot assisted extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer at our center during a 2-year period. Perioperative data, and oncological and functional results were prospectively recorded. RESULTS: Perioperative demographics included mean age, PSA and Gleason score, which were 60 years (range 42 to 76), 6.6 ng/ml (range 0.6 to 26) and 6 (range 5 to 9), respectively. Preoperative clinical stage was 81%, 16% and 3% for T1c, T2a and T2b, respectively. Average total operative time was 130 minutes (range 80 to 480). Intraoperative data included a mean blood loss of 196 cc with no open conversions. Bilateral, unilateral and nonnerve sparing prostatectomy was performed in 70%, 24% and 6% of patients, respectively. Of the patients 96% were discharged home within 8 to 23 hours of surgery. Pathological stage was pT2a, pT2b, pT3a and pT3b in 18%, 63%, 14% and 5% of all radical prostatectomy specimens, respectively, with an overall positive surgical margin rate of 13%. Two of 92 patients had positive nodal disease after lymph node dissection. Continence and erectile function were measured. CONCLUSIONS: The extraperitoneal approach offers the advantages of improved dexterity and visualization of the robot, while avoiding the abdominal cavity and potential associated morbidity. As surgeons gain more experience with this new technology, the extraperitoneal approach simulating the standard open retropubic technique is likely to gain popularity.

Adult↗

PubMed1996

Risk factors for progression in patients with prostate cancer treated with radical prostatectomy.

Adjuvant therapy after radical prostatectomy should ideally be limited to those patients at greatest risk for cancer recurrence, but identification of these patients remains a challenge. Although tumor volume has traditionally been regarded as the most important prognostic factor in patients with localized prostate cancer, a recent multivariate analysis has shown that tumor is not an independent predictor. Moreover, accurate measurement of tumor volume is extremely difficult. Preoperative serum prostate-specific antigen (PSA) levels have been identified as a significant independent predictor of progression. Disease-free survival is significantly better in patients with DNA-diploid prostate cancers than in those with nondiploid tumors. Histological grade is also a powerful predictor of disease progression. As a basis for selecting candidates for adjuvant therapy, clinical staging is too inaccurate and pathological staging too subjective. A recent Mayo Clinic study assessed the value of widely available clinical and laboratory parameters in predicting treatment failure after radical prostatectomy in 904 patients with pathologically organ-confined prostate cancer. Multivariate analysis identified Gleason score, preoperative serum PSA concentration, and DNA ploidy as independent predictors for progression. These risk factors were used to develop a scoring system that allows patients to be classified according to their risk of progression. Patients in the highest risk categories might be targeted for adjuvant therapy and closer surveillance, whereas those at lower risk might be followed less frequently.

Antineoplastic Agents, Hormonal↗

PubMed2006

Robotic radical prostatectomy: evolution from conventional to VIP.

Following the popularization of Vattikuti Institute Prostatectomy technique of robotic radical prostatectomy (RARP) by Menon et al., RARP has been gaining steady acceptance as a preferred alternative to both open and laparoscopic radical prostatectomy (LRP). Up until now, radical retropubic prostatectomy has been considered the gold standard for treatment of organ confined prostate cancer. Despite significant improvements in intraoperative blood loss and functional outcomes, driven primarily by the description of anatomical radical prostatectomy by Walsh, the perioperative morbidity, analgesic requirement, and recovery times have remained disadvantages of the open approach. LRP has been unable to gain widespread acceptance because of technical difficulty and a steep learning curve. The da Vinci assisted approach incorporates the advantages of minimally invasive approach while improving upon the results of the open approach. This paper traces the evolution of RARP and describes technical modifications incorporated at the Vattikuti Urology Institute including operative data, complications, and functional outcomes.

Humans↗

PubMed1989

[Urinary continence in patients undergoing nerve sparing radical prostatectomy].

Recently, the morbidity of radical prostatectomy has been reduced by improvements in surgical techniques and greater understanding of pelvic anatomy. The nerve sparing technique has been considered to be a major contribution to this advance. In our study, urinary control was compared in 33 consecutive patients undergoing a radical retropubic prostatectomy. In 13 patients, a conventional radical prostatectomy was performed and in 20 subsequent patients, a nerve sparing operation was performed. The staff surgeons were the same throughout the study. The age of the patients and pathological stage of the tumor were not significantly different between the groups. The operative time was shorter and intraoperative blood loss was less both significantly in the nerve sparing group. In the conventional operated group, there was one patient with total incontinence and two with significant incontinence requiring absorbable pads. In the nerve sparing group, there were no patients having total incontinence and one had stress incontinence requiring absorbable pads. Urethral pressure profile was measured postoperatively in 17 in the nerve sparing group and in 7 in the conventional group. The maximum urethral pressure in the nerve sparing group was 31.5 cm H2O (SD = 5.4) and in the conventional group 23.2 cm H2O (SD = 5.7) with a significant difference between groups (p less than 0.01). The functional urethral length of the nerve sparing group was 16.7 mm (SD = 5.2) and in the conventional group 13.3 mm (SD = 3.7) with no significant difference between the groups. These results suggest that preservation of neurovascular bundles from the pelvic plexus during radical prostatectomy has no important role in postoperative urinary continence.

Aged↗

PubMed1998

Influence of radical prostatectomy on serum hormone levels.

PURPOSE: The influence of radical prostatectomy on the hypothalamic pituitary axis has not been well studied. It is also unclear how alterations in serum androgen levels that result from surgical removal of the prostate might influence the recovery of libido and sexual function following radical prostatectomy. We determined the influence of radical prostatectomy on the hypothalamic pituitary testicular axis of 63 men with clinically localized prostate cancer treated only with radical prostatectomy. MATERIALS AND METHODS: A total of 63 healthy men 43 to 67 years old were enrolled in this prospective study. Phlebotomy was performed immediately before and 1 year following radical retropubic prostatectomy. Sera were stored frozen and analyzed as a group at the end of the study. We measured serum testosterone, percent free testosterone, dihydrotestosterone (DHT), estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin and prolactin. RESULTS: Following radical prostatectomy there was a statistically significant increase in serum testosterone, free testosterone, estradiol, LH and FSH (p <0.0001), and statistically significant decrease in serum DHT (p <0.0001). No difference was noted in serum sex hormone binding globulin or prolactin levels. There was no statistically significant correlation between any serum hormone and sample storage time, patient age or prostate volume that could limit potential bias in study design. Serum hormone changes did not correlate with pathological stage or histological grade for this group of patients. CONCLUSIONS: Radical prostatectomy influences the hypothalamic pituitary axis by increasing serum testosterone, percent free testosterone, estradiol, LH and FSH while decreasing serum DHT levels. These findings suggest that the sexual dysfunction associated with radical prostatectomy cannot be explained by androgen deficiency alone. These data further suggest that the normal prostate and/or prostate neoplasm could secrete a substance or substances that give negative feedback control to pituitary gonadotropin secretion. Further investigation is warranted to identify this substance or substances.

Adult↗

PubMed1999

p53 and bcl-2 immunohistochemistry in pretreatment prostate needle biopsies to predict recurrence of prostate cancer after radical prostatectomy.

PURPOSE: Immunohistochemical staining of radical prostatectomy specimens for p53 and bcl-2 proteins has been shown to correlate with prostate specific antigen (PSA) recurrence in a series of patients at our institution. We analyzed the relationship between staining of diagnostic prostate needle biopsies for p53 and bcl-2, and PSA recurrence. MATERIALS AND METHODS: From 1986 to 1993, 335 radical prostatectomies were performed at our hospital. Of the prostatectomy specimens 199 had been evaluated for p53 and bcl-2 proteins in a prior series. Of 139 patients with biopsy material available for analysis 129 had enough for evaluation of 1 or both markers. Prospectively obtained clinical followup data were available, with a mean followup of 6 years. Commercially available antibodies were used for immunohistochemical staining. RESULTS: The overall PSA recurrence rate was 37.6% for 199 radical prostatectomy cases and 37.9% for 129 with biopsy immunohistochemical staining. Staining of prostatectomies correlated well with PSA recurrence for p53 (p = 0.004) and bcl-2 (p = 0.001). However, biopsy staining did not correlate with prostatectomy staining or PSA recurrence for either marker. CONCLUSIONS: The p53 and bcl-2 biomarkers appear to be important to predict recurrence of prostate cancer when prostatectomy specimens are analyzed but this usefulness is not apparent with immunohistochemical staining of prostate biopsies. This difference may reflect sampling error and/or the heterogeneous nature of prostate cancers, and deserves further study.

Aged↗

PubMed2003

Combined reporting of cancer control and functional results of radical prostatectomy.

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA. Continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence of absence of biochemical progression (PSA>0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a score classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0+0+0): no cancer control-incontinence-impotence to 7 (4+2+1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or =4 had good cancer control, with no functional disorders for a score of 7 (4+2+1) (20%), no disorders of continence for a score of 6 (4+2+0) (31.5%), no disorders of erection for a score of 5 (4+0+1) (8.3%), or with incontinence and impotence for a score of 4 (4+0+0) (21.9%). All patients with a score <4 had a PSA>0.2 ng/ml, but with no functional disorders for a score of 3 (0+2+1) (2.4%), no incontinence for a score of 2 (0+2+0) (8.3%), and no impotence for a score of 1 (0+0+1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (score 0=0+0+0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗

PubMed2003

[How to present in a unique fashion the oncologic and functional results after radical prostatectomy].

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA and continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence or absence of biochemical progression (PSA > 0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a socre classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0 + 0 + 0): no cancer control-incontinence-impotence to 7 (4 + 2 + 1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or = 4 had good cancer control, wit no functional disorders for a score of 7 (4 + 2 + 1) (92%), no disorders of continence for a score of 6 (4 + 2 + 1) (31.5%), no disorders of erection for a score of 5 (4 + 0 + 1) (8.3%), or with incontinence and impotence for a score of 4 (4 + 0 + 0) (21.9%). All patients with a score < 4 had a PSA > 0.2 ng/ml, but with no functional disorders for a score for 3 (0 + 2 + 1) (2.4%), no incontinence for a score of 2 (0 + 2 + 0) (8.3%), and no impotence for a score of 1 (0 + 0 + 1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (socre 0 = 0 + 0 + 0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗

PubMed1997

Increasing incidence of minimal residual cancer in radical prostatectomy specimens.

Residual cancer in radical prostatectomy specimens from men with biopsy-proven adenocarcinoma occasionally may be difficult, or even impossible, to identify. Although this finding was recently described as "minimal residual cancer" or the "vanishing cancer phenomenon," there are no data on the incidence of this phenomenon in surgical pathology practice. We evaluated 3,038 consecutive radical prostatectomies performed at the Johns Hopkins Hospital between 1988 and 1995, excluding cases with a history of transurethral resection, prior therapy with a luteinizing hormone-releasing hormone agonist, focal Gleason grade 4 or 5, capsular penetration, or a positive surgical margin. Of this group, 84 cases with minimal or no residual cancer were identified. In 60 of these cases, residual cancer was "difficult to find" (mean total volume, 0.03 cc; range, 0.01-0.08 cc); in 20 cases, residual cancers were classified as "minute" (mean total volume, 0.07 cc; range, 0.03-0.13 cc). In four cases, no residual cancer could be identified, including two cases in which the diagnosis of cancer on needle biopsy was confirmed, one case in which review of the diagnostic needle biopsy revealed only high-grade prostatic intraepithelial neoplasia, and one case in which molecular analysis demonstrated mislabeling of the needle biopsy specimen. The annual incidence of minimal residual cancer increased from 0.5% in 1988 to 4% in 1993 and has begun to plateau at 3 to 4% since 1993 (p = 0.0016 for increasing trend). These data confirm the general impression that with more vigilant screening of men for prostate cancer, there has been an associated increase in cancer with little or no residual cancer at radical prostatectomy.

Adenocarcinoma↗