Contemporary results of anatomic radical prostatectomy

Authors

  • Dr. William J. Catalona MD,

    1. Catalona is Professor in the Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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    • Catalona's research was supported, in part, by grants from Hybritech Incorporated, Roche Diagnostics/Boehringer Mannheim Corporation, Pfizer Inc., UroMed Corporation, and Monsanto Company

  • Dr. Christian G. Ramos MD,

    1. Ramos and Carvalhal were Research Fellows in Urologic Surgery when this paper was written, and Dr. Carvalhal was supported, in part, by the Foundation for the Coordination of Higher Education and Graduate Training of the Brazilian Government, Brasilia, Brazil
    Current affiliation:
    1. Ramos is currently in the Division of Urology, Hospital de Trabajador, Asociacion Chilena de Seguridad in Santiago, Chile
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  • Dr. Gustavo F. Carvalhal MD

    1. Ramos and Carvalhal were Research Fellows in Urologic Surgery when this paper was written, and Dr. Carvalhal was supported, in part, by the Foundation for the Coordination of Higher Education and Graduate Training of the Brazilian Government, Brasilia, Brazil
    Current affiliation:
    1. Carvalhal is currently in the Department of Urology at the Pontifical Catholic University of Rio Grande do Sul in Porto Alegre, Brazil
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Abstract

With current clinical practice, most newly diagnosed cases of prostate cancer are potentially life-threatening yet still curable. The anatomical (nerve-sparing) radical prostatectomy has dramatically improved the results of surgical treatment. Other new management options, including conformal (three-dimensional) external beam radiation therapy, radioactive seed implantation (brachy-therapy), cryoablation, and hormonal therapy, may be useful in some patients, but they are all probably less effective than radical prostatectomy.

Suitability for radical prostatectomy generally requires a clinically localized, potentially life-threatening tumor [as defined by Gleason grade, tumor stage, and serum prostate-specific antigen (PSA) level], a life expectancy of 10 years, and no serious co-morbid medical conditions.

With contemporary radical prostatectomy, about 70% of men with clinically localized disease will be cured, depending on tumor grade, tumor stage, and the serum PSA level.

Urinary continence and sexual potency can be preserved in most patients, but substantially better results have been reported from centers of excellence than from community-based series. Other complications occur in about 10% of patients and with greater frequency in older patients. The operative mortality rate is less than 0.5%.

Neoadjuvant hormonal therapy does not appear to affect treatment failure rates in patients undergoing radical prostatectomy. Prostatectomy may be beneficial in patients with microscopic lymph node metastases. Postoperative adjuvant radiotherapy may also be beneficial for patients with adverse pathologic findings.

Salvage radical prostatectomy after radiation failure is associated with a 10-fold higher risk of complications and limited prospects for cure.

Prospective, randomized clinical trials are underway to compare the results of radical prostatectomy with other treatments. Currently, radical prostatectomy is considered the preferred treatment for men with localized disease and a 10-year life expectancy.

Ancillary