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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↗
PubMed2001

Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases.

PURPOSE: The laparoscopic access for radical prostatectomy offers an alternative to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results. MATERIAL AND METHODS: From June 1999 to September 2000, we performed 125 laparoscopic prostatectomies. These included only patients with cancer stages T1 or T2. The mean PSA concentration was 10.5 ng/ml. Forty-four percent of the patients had undergone previous abdominal and 19% previous transurethral surgery. For our laparoscopic prostatectomies we used the descending technique. Free-hand laparoscopic suturing and in situ knot-tying technique were used for the urethrovesical anastomosis. The mobilized specimens were removed in an endobag via a muscle splitting incision. RESULTS: All 125 procedures could be completed successfully. No case required conversion to open surgery. The average operating time was 255 min, the last 40 procedures taking 200 min only. Mean blood loss was 185 ml. Two patients (2%) required postoperative blood transfusion. After an initial learning curve, catheter remained in place for an average of 5.5 days, and the average postoperative stay in hospital was 8 days. Intraoperative complications were seen in 5 patients (4%). In 13 patients (10.4%) postoperative complications were observed. 86% of the patients are continent 6 months postoperatively. Preservation of the neurovascular bundle and sexual potency is possible. CONCLUSION: Laparoscopic radical prostatectomy is an ambitious procedure with a steep learning curve, especially for the laparoscopic dissecting and suturing technique. The excellent sight for dissection results in a reduced blood loss and faster convalescence with an overall lower morbidity. Also with regard to oncological and functional (continence) results the minimally invasive access is at least equivalent to the open procedure. In our opinion, laparoscopic prostatectomy will be the future method of choice for radical prostatectomy.

Adult↗
PubMed1988

Carcinoma of the prostate following suprapubic prostatectomy for benign hyperplasia.

We report on 25 patients who developed carcinoma of the prostate following suprapubic prostatectomy for benign hyperplasia. The average age at the time of surgery was 67.3 years. An average of 8.3 years (1-23 years) elapsed before detection of carcinoma. 12 of 25 patients were operated on at the Department of Urology, University of Vienna, between 1962 and 1986. At the same time, 972 patients underwent suprapubic prostatectomy. In our patients the incidence of carcinoma of the prostate following suprapubic prostatectomy amounts thus to at least 1.2% (12 of 972). In Austria, the incidence of carcinoma of the prostate in the comparable age group (70-79 years) is 0.34% per annum. This means that in an average observation period of 6.4 years (i.e. the average time before detection of carcinoma in 12 of 972 patients), almost 2.2% of the male population in Austria are affected by carcinoma of the prostate. Probably, part of the patients who underwent prostatectomy at our department turned to other departments of urology as soon as the complaints reappeared. Hence we may conclude that the incidence of carcinoma of the prostate following prostatectomy is almost identical with the incidence of carcinoma in a non-operated group. To determine the incidence of carcinoma of the prostate following suprapubic prostatectomy, 276 patients were called in again. Of these, 98 underwent follow-up examinations; no carcinoma of the prostate was detected. Since the biologic activity of the carcinoma after open prostatectomy is similar to that of nonoperated carcinoma, urologic follow-up examinations must be carried out regularly both in patients who underwent adenomectomy and in those who were not operated.

Aged↗
PubMed1998

Prostate-specific antigen doubling times are similar in patients with recurrence after radical prostatectomy or radiotherapy: a novel analysis.

PURPOSE: Some investigators have analyzed the rate of growth of prostate cancer that has recurred after definitive radiotherapy or radical prostatectomy using serum prostate-specific antigen (PSA) doubling times (DT). We examined all PSA values in recurrent patients to determine the pattern and rate of increase in PSA after radiation therapy and radical prostatectomy. PATIENTS AND METHODS: Charts of 96 recurrent radical prostatectomy patients (mean age, 62.8 years; range, 47 to 76) and 42 recurrent radiation therapy patients (mean age, 67.2 years; range, 52 to 83) were reviewed. All available PSA values between the date of operation/radiation treatment and last follow-up evaluation or the initiation of second-line therapy are included. Rate of PSA DT was not assumed to be constant over time; it was instead allowed to vary. We use a piecewise linear random-coefficients model in time for log (PSA), which allowed different mean models for both treatments. RESULTS: The PSA DT in the first year after radiation therapy was--1.17 years, which reflects the continuous decline in PSA in the average patients during the first year after radiotherapy despite eventual biochemical progression. In contrast, the PSA DT in the radical prostatectomy group was 0.66 in the first year. In year 2, after radiation therapy, the PSA DT was lengthy at 1.82 years, significantly longer (P = .0025) than in the radical prostatectomy group (0.76 years). After year 2, there were no significant differences between the two groups (P > .05). CONCLUSION: A piecewise linear random-coefficients model enables interval analysis of PSA DT. While the PSA DT after radiation therapy and radical prostatectomy are different in the first 2 years, the rate of increase in PSA appears to be similar in the two groups after year 2, which suggests the rate of growth of cancers that recur after radiation therapy and radical prostatectomy is similar.

Aged↗
PubMed1992

[Results of total prostatectomy for treatment of prostatic cancer].

Between 1970 and 1989, total prostatectomy was performed in 31 patients with prostatic cancer at the Department of Urology, Tokyo Metropolitan Fuchu Hospital. These cases were composed of 4 cases of stage A, 8 cases of stage B and 19 cases of stage C. The surgical procedures were perineal prostatectomy in 25 cases, combined method of perineal and retropubic prostatectomy in 5 cases and transsacral prostatectomy in one case. Blood loss was 762 ml on the average. Blood transfusion was unnecessary in 15 cases all of whom underwent perineal prostatectomy. Endocrine or radiation therapy were administered after total prostatectomy to 23 or 13 cases, respectively. Postoperative complications included early postoperative death due to apoplexy in 1 cases, recto-vesical fistula in 1, bladder neck or urethral stricture in 9 (mild 7, severe 2) and urinary incontinence in 20 (mild 13, moderate 4, severe 3). Frequency and grade of urinary incontinence tended to become higher as the pathological stage progressed. The 5-year survival rates for clinical stage A and B, and C were 83% and 63%, respectively. We conclude that total perineal prostatectomy was less traumatic operation for prostatic cancer, and would be indicated in clinical stage A and B for radical operation and in stage C for one of the combination therapy.

Aged↗
PubMed2000

Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy.

PURPOSE: We determined the incidence of patient self-reported post-prostatectomy incontinence, impotence, bladder neck contracture and/or urethral stricture, sexual function satisfaction, quality of life and willingness to undergo treatment again in a large multicenter group of men who underwent radical prostatectomy. We also determined whether the morbidities of sexual function satisfaction, quality of life and bladder neck contracture and/or urethral stricture are predictable from demographic and postoperative prostate cancer factors. MATERIALS AND METHODS: A self-reporting questionnaire was completed and returned by 1,069 of 1,396 eligible patients (77%) who underwent radical prostatectomy between 1962 and 1997. Of the respondents 868 (85.7%) underwent surgery after 1990 and in all prostatectomy had been done a minimum of 6 months previously. Questionnaire results were independently analyzed by a third party for morbidity tabulation and the association of patient reported satisfaction. RESULTS: The patient self-reported incidence of any degree of post-prostatectomy incontinence, impotence and bladder neck contracture or urethral stricture was 65.6%, 88.4% and 20.5%, respectively. The incidence of incontinence requiring protection was 33% and only 2.8% of respondents had persistent bladder neck contracture or urethral stricture. Although incontinence and impotence significantly affected self-reported sexual function satisfaction, quality of life and willingness to undergo treatment again (p = 0.001), 77.5% of patients would elect surgery again. This finding remained true even after adjusting for demographic variables, and the time between surgery and the survey by multiple logistic regression. CONCLUSIONS: Although radical prostatectomy morbidity is common and affects self-reported overall quality of life, most patients would elect the same treatment again. Impotence and post-prostatectomy incontinence were significantly associated with sexual function satisfaction, quality of life and willingness to undergo treatment again. Bladder neck contracture and/or urethral stricture was associated with willingness to undergo treatment again after adjusting for demographic variables and time from surgery to the survey.

Adult↗
PubMed2000

Salvage radical prostatectomy for radiorecurrent prostate cancer: morbidity revisited.

PURPOSE: With the advent of prostate specific antigen (PSA) testing and transrectal ultrasound guided prostate biopsy there has been stage migration in the diagnosis of prostate cancer, so that more younger men are being diagnosed with organ confined prostate cancer. Many patients elect radiation therapy, while some have recurrent or new prostate cancer with absent systemic disease and life expectancy greater than 10 years. We present our experience with salvage radical prostatectomy in these cases. MATERIALS AND METHODS: Between 1995 and 2000, 6 men treated with curative intent with radiotherapy for prostate cancer were subsequently treated with salvage surgery for clinically localized prostate cancer. All men had biopsy proved recurrent or persistent prostate cancer, increasing serum PSA, no evidence of systemic disease at surgery and life expectancy greater than 10 years. We assessed the morbidity associated with this procedure and compared results to those in the contemporary literature. RESULTS: Six patients underwent salvage radical prostatectomy. Initial pre-radiation PSA was 4.5 to 15.7 ng./ml. Pre-radiation disease was clinical stage T1c in 5 cases and B2 in 1. The interval from radiotherapy to repeat biopsy was 12 to 48 months. A mean of 6.3 months after local recurrence was detected and before salvage radical prostatectomy was performed 4 patients underwent androgen deprivation therapy. Mean operative time was 195 minutes, intraoperative blood loss was 680 cc, and hospital stay and catheterization time were 3.2 and 13.8 days, respectively. There were no rectal injuries. All 6 patients are impotent, 5 are continent and 1 has mild stress incontinence. There was biochemical failure in 1 case 36 months after salvage radical prostatectomy and no evidence of recurrence in the remaining 5 at a mean followup of 27 months. CONCLUSIONS: Salvage radical prostatectomy is a technically challenging procedure. In the past it was associated with a high incidence of rectal injury, urinary incontinence and anastomotic stricture. The results of our relatively small series are encouraging and concur with those of recent studies that the morbidity of salvage radical prostatectomy is lower than previously reported. We believe that salvage radical prostatectomy may be considered a reasonable treatment option in appropriate patients with radiorecurrent prostate cancer.

Aged↗
PubMed2001

Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer.

PURPOSE: Because of the recent increase in nonpalpable prostate cancer (clinical stage T1c) in men, preoperative needle biopsy findings have had an important role for treatment decisions. We examine the correlation among histopathological features of 6 systematic biopsies and radical prostatectomy specimens in which 1 investigator reviewed all histological sections. MATERIALS AND METHODS: We studied a total of 450 men with clinical stage T1c prostate cancer from whom needle biopsies were matched with radical prostatectomy specimens, and selected 222 patient biopsies that were obtained from 6 or more separate regions of the prostate. The pretreatment parameters of serum prostate specific antigen (PSA), PSA density, number of positive needle biopsies, distribution of positive cores, linear cancer length, and percent Gleason grade 4/5 on the biopsy were determined and compared with histopathological features of prostate cancer in the radical prostatectomy specimens. All biopsies and radical prostatectomies were evaluated morphologically at the department of urology. RESULTS: Of the 222 men the largest cancer was clinically insignificant in 23 (10%), as measured by a cancer volume of less than 0.5 cc. Cancer volume in the prostatectomy specimen was significantly related to all parameters in the biopsy, with the surprising exception of cancer distribution in the positive biopsies. However, all of these correlations with cancer volume were weak, with Pearson's correlation squared (R(2)) multiplied by 100 less than 10%. Unfortunately, tumor grade on the biopsy agreed with the prostatectomy specimen in only 81 of 222 (36%) cases. Grade assessment with needle biopsy underestimated the tumor grade in 102 (46%) cases and overestimated it in 39 (18%). No single parameter in the biopsy was a predictor of tumor significance, as measured by a cancer volume of greater than 0.5 cc. However, the best model to predict a tumor less than 0.5 cc in volume was the combination of a single positive core with cancer length less than 3 mm. that contained no Gleason grade 4/5. The use of PSA or PSA density in combination with needle biopsy findings did not enhance prediction of tumor significance. CONCLUSIONS: These results indicate a weak and disappointing correlation among all pathological features of 6 systematic biopsies and radical prostatectomy specimens. The combination of 1 positive core with cancer length less than 3 mm. that contains no Gleason grade 4/5 is probably the best predictor of prostate cancer less than 0.5 cc in men with nonpalpable tumors, a cancer volume that occurred in only 10% of the 222 (23) men.

Adenocarcinoma↗
PubMed2001

[Importance of transrectal ultrasonography in the detection of local recurrence of prostatic carcinoma after radical prostatectomy].

OBJECTIVE: To assess the importance of transrectal ultrasonography in early detection of local recurrence of prostate carcinoma in patients after radical retropubic prostatectomy and compare it with digital rectal examination and the level of prostatic specific antigen. PATIENTS AND METHODS: In a group of 72 patients, at least six months after radical prostatectomy regularly after 3-6-month intervals the levels of prostatic specific antigen were monitored. When the level of specific prostatic antigen was repeatedly higher than 0.2 ng/ml or when it increased as compared with the previous examination the patient was submitted to digital rectal examination and transrectal ultrasonography of the bed after radical prostatectomy. In case of a positive sonographic finding, ultrasound-guided biopsy was performed. RESULTS: A local recurrence of the disease was confirmed by ultrasound-guided biopsy in 5 (6.9%) of 72 investigated patients on average 51 months (23-81) after radical prostatectomy. The mean preoperative value of the prostatic specific antigen was in these patients 23.4 ng/ml (10.6-33). In all patients the authors detected by transrectal ultrasonography a hypoechoic focus at the site of anastomosis. Of 5 patients with a local recurrence of the disease two (40%) had a negative digital rectal examination. CONCLUSION: The prostatic specific antigen monitored most accurately the local progression of the disease after radical prostatectomy. Transrectal ultrasonography detected a local recurrence of the disease in all five patients despite the negative digital rectal examination. Transrectal ultrasonography makes guided biopsy from the site of radical prostatectomy possible and thus increases the detection rate of local progress of the disease as compared with digital rectal examination. Elevation of the prostatic specific antigen with subsequent transrectal ultrasonographic examination makes it possible to detect as soon as possible early local recurrence of prostate carcinoma after radical prostatectomy.

Aged↗
PubMed1988

Long-term results of radical prostatectomy in clinically localized prostate cancer: experience at the Johns Hopkins Hospital.

The objectives of our retrospective long-term analysis of radical prostatectomy at The Johns Hopkins Hospital are to determine the efficacy of radical prostatectomy and the optimal statistical method for ascertaining survival following therapeutic intervention for men with clinically localized prostate cancer. The duration of survival and the cause of death were ascertained for 57 men with clinical stage B1 prostate cancer who had radical prostatectomies at The Johns Hopkins Hospital between 1951 and 1963. The absence of metastatic disease was determined by radiographic survey of the bones only. The survival curve determined by the direct method was virtually identical to the projected survival curve for a 62-year-old man in 1960. The cause-specific actuarial survival analysis indicated that only 14% of the men with stage B1 disease and a 15-year life expectancy will develop metastatic prostate cancer following radical prostatectomy. The cause-specific survival curve plateaued after 10 years, which indicated that the majority of men surviving 10 years free of disease are cured of the disease. Survival analysis was also determined by the direct method for 48 men with clinical stage B2 prostate cancer who had undergone radical prostatectomy between 1951 and 1963. Overall, the survival rates for these men were considerably lower than those for similarly treated men with clinical stage B1 disease. The survival curves following radical prostatectomy for men with stage B1 disease and clinical stage B2 disease pathologically confined to the prostate were similar. Radical prostatectomy for stage B1 disease was performed with minimal morbidity, and potency was preserved in most patients with the use of nerve-sparing modifications.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

[Rebirth of perineal prostatectomy in the era of laparoscopic lymphadenectomy].

UNLABELLED: Radical prostatectomy has become the gold standard treatment for localized prostate cancer. With the introduction of Laparoscopy Lymphadenectomy for Staging of Prostate Cancer in 1991, interest in the perineal approach to radical prostatectomy has been renewed. Historically, the perineal approach has proven to be less morbid than the retropubic counterpart. Herein, the authors report their experience with 98 male patients with clinically localized T2B (or less) Cancer of the Prostate who underwent Laparoscopic Lymphadenectomy of which 83, subsequently, had a radical perineal prostatectomy. The mean follow up of this group of patients was 16.5 months. Clinicopathological results are discussed and compared with the results of radical retropubic prostatectomy in the literature. IN CONCLUSION: (1) laparoscopic lymphadenectomy with radical perineal prostatectomy are less morbid, with a faster recovery rate than the standard radical retropubic prostatectomy approach. (2) as better non-surgical methods evolve in predicting the status of the pelvic lymph nodes, reserving laparoscopic lymphadenectomy for patients with high risk of developing lymph nodes' metastasis, the perineal prostatectomy and laparoscopic lymph node dissection are becoming the state of the art treatment in patients with localized prostate cancer.

Aged↗
PubMed1996

[Treatment of localized prostate cancer: radical prostatectomy versus radiation therapy].

Between 1982 and 1990, 57 patients with prostate cancer (clinical stage T2-3) underwent pelvic lymphadenectomy at Fukui Medical School or Toyooka Public Hospital. The patients were subsequently treated either by radical prostatectomy (39 cases) or external radiation therapy (18 cases). The patients were between 56 and 85 years old (Mean 73). The outcome of the 47 patients without lymph node metastasis (prostatectomy 33, radiation 14) was examined. The 5-year disease-specific survival rate was 96% for the patients treated by prostatectomy and 93% for those treated by radiation. The 5-year progression-free survival rate for the prostatectomy group and radiation group was 94% and 41%, respectively (P = 0.004). The outcome of the 10 patients with lymph node metastasis (prostatectomy 6, radiation 4) was not satisfactory because of the high progression rate in the two groups (5-year progression-free survival, 22% in prostatectomy and 25% in radiation group). In the patients with no metastasized lymph nodes, we should choose radical prostatectomy, if our goal is to cure the patients.

Aged↗
PubMed1997

Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy.

PURPOSE: Urodynamic evaluations were done in patients before and after radical prostatectomy to obtain more information about the factors that affect continence. MATERIALS AND METHODS: Urodynamic testing was done in 82 patients before, and 6 to 8 weeks and 6 months (9 cases) after radical prostatectomy. Evaluation included measurement of cystometric bladder capacity, compliance, functional profile length, maximal urethral closure pressure, maximal urethral closure pressure during voluntary contraction of the external sphincter, residual urine, maximal flow rate and bladder instability. RESULTS: The continence rate was 33.4, 69.4, 84.7 and 90.9% at 1, 3, 6 and 12 months after radical prostatectomy, respectively. Mean functional urethral length decreased from 61 mm. preoperatively to 25.9 mm. postoperatively, maximal urethral pressure from 89.6 to 65.2 cm. water and bladder capacity from 338.7 to 278.8 ml. Bladder instability was found in 17 and 41% of cases before and directly after radical prostatectomy, respectively. There was a statistically significant difference in maximal urethral closure pressure (68.1 versus 53.1 cm. water) as well as functional urethral length (27.6 versus 20.5 mm.) in continent versus incontinent patients, respectively. Urodynamic examination 6 months after prostatectomy showed an increase in functional profile length and maximal urethral pressure, while bladder measurements did not change significantly. CONCLUSIONS: After radical prostatectomy significant changes in bladder and sphincter measurements are noted. Urethral closure pressure, functional urethral length and bladder stability are significant urodynamic factors that influence continence after radical prostatectomy.

Adult↗
PubMed1997

Accelerated tumor proliferation rates in locally recurrent prostate cancer after radical prostatectomy.

PURPOSE: We compared the growth rates of primary cancer and prostatic fossa recurrence after radical prostatectomy. MATERIALS AND METHODS: Tumor proliferative rates were studied in 26 patients with biopsy proved prostatic fossa recurrences after radical prostatectomy. Proliferation was calculated in the prostatectomy specimens and in recurrent cancer using Ki-67 antibody to detect dividing cells. RESULTS: Mean and median labeling indexes for radical prostatectomy specimens were 2.96 and 2.51, respectively. Labeling indexes in locally recurrent tumors were significantly higher (mean 6.47, median 5.59, p < 0.001). The increase in labeling index between parent and recurrent tumors was unrelated to pathological staging at prostatectomy or interval from radical prostatectomy. CONCLUSIONS: Tumors that recur locally after radical prostatectomy appear to have a higher proliferative rate compared to parent tumors.

Cell Division↗
PubMed1998

Secular changes in radical prostatectomy utilization rates in Olmsted County, Minnesota 1980 to 1995.

PURPOSE: We estimated the changes in utilization of radical prostatectomy for treatment of prostate cancer and describe the clinical characteristics of men undergoing radical prostatectomy in a population based setting. MATERIALS AND METHODS: The Rochester Epidemiology Project was used to identify all Olmsted County residents who underwent radical prostatectomy from 1980 to 1995. The community medical records of these men were reviewed to determine the clinical and pathological stage and grade at biopsy and following surgery. RESULTS: From 1980 to 1995, 311 radical prostatectomies were performed on Olmsted County men. From 1980 to 1987 prostatectomy rates ranged from 6.3 to 31.0/100,000 men but rates increased dramatically to 53.6/100,000 in 1988 and 106.2/100,000 in 1992. The rate after 1992 decreased to 53.0/100,000 and then increased slightly to 80.4/100,000. There was a shift to younger age in more recent times (mean patient age 65.4 years in 1980 to 1986 and 62.4 in 1993 to 1995, p = 0.02), a nonsignificant (p = 0.10) trend toward lower pathological stage in recent years (42% stage pT2 in 1980 to 1986 versus 55% in 1993 to 1995) and a significant decrease in the proportion of cases of disease up staged following surgery (53% in 1980 to 1986 versus 37% in 1993 to 1995, p = 0.03). There was no significant trend in pathological grade with time (63% Mayo grade I or II in 1980 to 1986 versus 52% in 1993 to 1995, p = 0.30). CONCLUSIONS: These findings demonstrate an increase in radical prostatectomy rates that coincided with increases in prostate cancer incidence. There was a decrease in population prostatectomy rates in 1993 which was followed by modest increases to levels lower than the peak in 1992. However, the clinical characteristics of patients during this period did not change dramatically, suggesting that in a population based setting the selection factors for patients undergoing surgical treatment may not have changed.

Adult↗
PubMed1998

Radiation therapy for the management of biopsy proved local recurrence after radical prostatectomy.

PURPOSE: We determine which clinical characteristics correlate with a successful outcome following external beam radiation for the management of biopsy proved, locally recurrent prostate cancer after radical prostatectomy. MATERIALS AND METHODS: The clinical records of 34 patients who were treated at our institution with external beam radiation for biopsy proved local disease recurrence after radical prostatectomy were reviewed. Mean followup was 77.9 months after radical prostatectomy and 38.3 months after radiotherapy. Preoperative, postoperative and pathological characteristics were examined for the ability to predict failure following radiotherapy. RESULTS: Of the 34 patients 9 (26%) exhibited persistently low and stable serum prostate specific antigen (PSA) (less than 0.5 ng./ml.), while 7 (21%) had an undetectable serum PSA (less than 0.1 ng./ml.) during followup. These 16 patients were considered to be successfully treated by radiation and in the remaining 18 (53%) radiation was considered to have failed. The likelihood of successful treatment at 3 years after radiotherapy for all patients was 48%. Preoperative PSA, PSA at first elevation, postoperative PSA velocity and pathological stage were not significant predictors of a successful outcome following radiation treatment. Patients with a serum PSA of 4 ng./ml. or less before receiving radiotherapy and those with a prostatectomy specimen Gleason score of 7 or less were significantly more likely to be successfully treated by radiotherapy. CONCLUSIONS: Radiation therapy is a viable treatment option for select patients with biopsy proved local disease recurrence following radical prostatectomy. The chance of achieving and maintaining a persistently low and stable or undetectable serum PSA is likely in those patients with a prostatectomy specimen Gleason score of 7 or less and a pre-radiation PSA of 4.0 ng./ml. or less. More effective treatment regimens are needed for those patients in whom radical prostatectomy fails.

Aged↗
PubMed1993

Stage D1 prostate cancer. A nonrandomized comparison of conservative treatment options versus radical prostatectomy.

BACKGROUND: Untreated Stage D1 prostate cancer is associated with a high progression rate. Various treatment modalities involving monotherapy alone have been associated with dismal results. In this retrospective study, the impact of combination therapy, local (surgery or radiation) and systemic (hormonal), compared with that of monotherapy on disease outcome was evaluated. METHODS: The authors reviewed 631 patients who underwent pelvic lymphadenectomy for Stage D1 prostate cancer: 251 had radical prostatectomies and orchiectomies, 78 had radical prostatectomies alone, 97 received local irradiation and underwent orchiectomies, and 60 had orchiectomies alone. RESULTS: Cause-specific survival rates for prostatectomy-orchiectomy-treated (PO) patients at 5 and 10 years were 91% and 78%, respectively; they were 84% and 54% for irradiation-orchiectomy-treated (IO) patients and 66% and 39% for orchiectomy alone-treated (O) patients, respectively. Controlling for the number of nodes, the difference between PO-treated and IO-treated patients was not significant; the former group had a significantly longer survival than the O-treated patients (P = 0.037). The 5-year and 10-year cause-specific survival rates for prostatectomy alone-treated patients were 91% and 75%, respectively, and 84% and 45% for irradiation alone-treated patients. Thus, cause-specific survival rates in prostatectomy alone-treated patients were significantly better (P = 0.0085). CONCLUSIONS: For patients with Stage D1 prostate adenocarcinoma, radical prostatectomy and local irradiation as local treatments when combined with orchiectomy produce similar outcomes. These results should be verified in a prospective study.

Biomarkers, Tumor↗
PubMed2004

Long-term outcomes after radical prostatectomy performed in a community-based health maintenance organization.

BACKGROUND: Radical prostatectomy is used widely for the treatment of patients with localized prostate carcinoma. No long-term analysis has been reported on a series of radical prostatectomies performed in a community-based health maintenance organization. METHODS: Charts and histologic slides were reviewed from 750 patients who underwent radical prostatectomy between 1970 and 1996 at a community-based health maintenance organization. The influences of a number of variables were analyzed for their impact on progression free survival (PFS) and overall survival (OS). RESULTS: With a median follow-up of 6.2 years among survivors, 137 patients (18%) had progressive disease, and 149 patients (20%) died from all causes. The median OS from the date of diagnosis was 15.7 years (95% confidence interval, 13.6-17.2), similar to the expected median survival of 16.2 years. The median PFS from diagnosis was not reached, but 75% of patients were progression free > or = 10.6 years after undergoing prostatectomy. The prognostic factors included Gleason score, age at diagnosis, and T stage. Outcomes were comparable with reports of surgical series from university-based practices. CONCLUSIONS: The patient characteristics that had important, favorable correlation with survival included Gleason score < or = 6, T1 or T2 tumor status, and younger age at diagnosis. Lower prostate-specific antigen values at diagnosis, together with the former two parameters, also had a favorable correlation with PFS. Radical prostatectomy in a community-based health maintenance organization was followed by long-term PFS and OS comparable to outcomes reported from university-based practices. The impact of radical prostatectomy on survival remains to be demonstrated.

Adenocarcinoma↗