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PubMed2004

[The perioperative charge equivalence of radical prostatectomy with 1-year follow up since the diagnosis of prostate cancer].

We assessed the 1-year charges in the group of patients undergoing radical prostatectomy and the changes in hospital costs and resource use following implementation of a clinical care path. A total of 69 consecutive men treated with radical prostatectomy for clinically localized prostate cancer were enrolled in the study. Hospital and outpatient records were analyzed for each patient in regard to preoperative, operative and postoperative charges of a 12-month period. Parameters included number of encounters, diagnostic and therapeutic interventions, hospitalization and operative charges, and follow-up visits, diagnostic tests and interventions for 1 year. The mean first-year cost of treatment with radical prostatectomy for localized prostate cancer was 144 x 10(4) yen. The increases in the first-year cost with higher prostate specific antigen (PSA) level for the diagnosis level appeared to primarily be associated with increased inpatient resource use and greater use of hormonal therapy. Length of the stay in a hospital significantly influenced the first-year cost. After implementation of the radical prostatectomy care path hospital costs decreased by 30% (66 x 10(4) yen vs 46 x 10(4) yen), total costs decreased 40% (190 x 10(4) yen vs 113 x 10(4) yen) and length of hospital stay decreased by 56% (37.0 vs 16.6). The first-year costs with radical prostatectomy are influenced greatly by the hormonal therapy and the number of hospital days. By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved toward shorter hospital stays and lower hospital costs.

Age Factors↗
PubMed2004

Inguinal hernia after radical retropubic prostatectomy--experience of Kaohsiung Veterans General Hospital.

BACKGROUND: Radical retropubic prostatectomy is a potentially curative treatment for localized prostate cancer. This study aimed to examine the incidence of developing inguinal hernia after radical retropubic prostatectomy and its possible factors. METHODS: From November 1990 to April 2002, there were 222 patients in Kaohsiung Veterans General Hospital who underwent radical retropubic prostatectomy and pelvic lymph node dissection for localized prostate cancer. Another 200 patients with prostate cancer who did not receive surgical intervention were enrolled as the control group. The medical charts were reviewed with an emphasis on the possible mechanisms causing inguinal hernia. RESULTS: The period of follow-up ranged from 2 to 137 months, with a median of 54 months. There were a total of 15 (6.7%) patients who developed inguinal hernia after radical retropubic prostatectomy and pelvic lymph node dissection in our hospital. Post-prostatectomy anastomotic stricture was noted in 7 (46%) patients. Ten patients (67%) developed indirect type inguinal hernia. Only 4 (2%) inguinal hernias were found in the control group. CONCLUSIONS: The incidence of inguinal hernia among patients undergoing radical retropubic prostatectomy and pelvic lymph node dissection was higher than that among patients without operation. Post-operative anastomotic stricture was the most important predisposing factor in the current study.

Aged↗
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↗
PubMed2004

[Ganglionar metastization on radical prostatectomy].

OBJECTIVES: To analyze retrospectively 19 patients with positive pelvic lymph node disease obtained with a radical prostatectomy. To discuss the actual role of pelvic lymphadenectomy and evaluate the results obtained using one treatment protocol. PATIENTS AND METHODOLOGY: Between January 1993 and December 2001 450 patients underwent radical prostatectomy for localized prostate cancer. Nineteen patients were identified as having positive ganglionar disease (4.2%). The mean PSA value of the 450 patients was 11.8 ng/ml (ranging 1.9 - 40 ng/ml). We analyzed the survival curves using the method of Kaplan-Meier, based on non recurrence of elevated biochemical total PSA values. The mean follow up time was 37.7 months. The recurrence of disease was defined by two consecutive determinations of PSA values greater than 0.2 ng/ml. RESULTS: the mean age of the nineteen patients was 66 years, varying between 56 and 74. The specific survival curve for these patients shows a survival probability of 60.9%, after 5 years. The survival curve of biochemical free recurrence shows a probability of 37.5%, after 5 years. DISCUSSION: A progressive decrease in the incidence of patients with ganglionar disease was observed after radical prostatectomy. It is therefore disputable the role of routine lymphadenectomy, its advantages, disadvantages and indications. The scientific analysis have permited great controversy regarding treatment. Our results with a treatment protocol which utilizes preventive adjuvant radiotherapy together with hormone treatment, initially differed and actually systematic, shows a survival rate similar to other studies. CONCLUSIONS: The actual indication of lymphadenectomy is maintained in radical retropubic prostatectomy and in patients with a risk of extracapsular disease in perineal prostatectomy or laparoscopy prostatectomy. The monotherapy offers a limited potential of cure. An extensive disease needs an aggressive therapy. A combination of adjuvant radiation therapy and simultaneous hormone treatment is indicated until there exists a randomized study, with an adequate follow up time, to determine which treatment strategy is the best.

Aged↗
PubMed1994

[Comparison of treatment results of prostatic cancer between radical prostatectomy and radiation therapy].

Between 1982 and 1990, 55 patients with prostate cancer (clinical stage A2-C) underwent pelvic lymphadenectomy at the Public Toyooka Hospital. The patients were subsequently treated either by radical prostatectomy (36 cases) or external radiation therapy (19 cases). The age of the patients varied from 56 to 85 (Mean 73.1). The outcome of the 46 patients with negative lymph node (prostatectomy 31, radiation 15) were compared. The 10-year disease-specific survival rates were 100% for the patients treated by prostatectomy and 78% for those treated by radiation (P = 0.035). The 5-year progression-free survival rates for the prostatectomy group and radiation group were 97% and 56%, respectively (P = 0.013). Among the radiation groups, patients with well differentiated carcinoma showed a lower progression rate as compared to those with moderately or poorly differentiated carcinoma (5-year progression-free survival, 81 vs 20%, P = 0.094). The outcome of the 9 patients with positive lymph node (prostatectomy 5, radiation 4) was not satisfactory because of the high progression rates in the two groups (5 year progression-free survival, 30% in prostatectomy and 25% in radiation group).

Aged↗
PubMed1993

[Perineal radical prostatectomy in the age of laparoscopy].

With the advent of laparoscopic lymphadenectomy, attention has been focussed again to the perineal approach for cancer of the prostate. The high rate of postoperative impotence and the abdominal incision required had made radical perineal prostatectomy unpopular. From August 1990 to July 1991, 76 patients with localized prostate cancer were surgically treated at the University of St. Louis. These patients were divided into three groups; group A comprised 26 patients who were submitted to laparoscopic lymphadenectomy and radical perineal prostatectomy, group B comprised patients treated by laparoscopic lymphadenectomy and radical retropubic prostatectomy, and group C or controls underwent open lymphadenectomy and radical retropubic prostatectomy. Fifty-three patients were sexually potent preoperatively but only 20 (7 from group A, 5 from group B and 8 from group C) were considered for preservation of the neurovascular bands. All the patients were followed for a minimum of one year. Comparison of these three groups revealed significant differences for perioperative bleeding and postoperative hospital stay in favor of Group A. The overall stress incontinence rate was 5.3% and the complications ranged from 4.1% for group C and 29.1% for group B. The postoperative sexual potency ranged from 57% for group A to 75% for group C, the differences not being statistically significant. Radical perineal prostatectomy is as valid as radical retropubic prostatectomy for localized prostatic cancer and has the advantages of less bleeding and a faster recovery, particularly if combined with laparoscopic lymphadenectomy.

Aged↗
PubMed1996

Impact of moderate dose of postoperative radiation on urinary continence and potency in patients with prostate cancer treated with nerve sparing prostatectomy.

PURPOSE: We analyzed the impact on potency and urinary continence of moderate doses of radiation (45 to 54 Gy.) given postoperatively after nerve sparing prostatectomy. MATERIALS AND METHODS: Between 1983 and 1992, 294 of 762 prostate cancer patients were selected to undergo nerve sparing prostatectomy. Subjective patient reports regarding potency and urinary continence status were obtained preoperatively, 1 year postoperatively or 1 year after completion of radiation. RESULTS: Of the 294 patients 105 received postoperative radiotherapy (45 to 54 Gy.) to the prostatic bed. There were patients with more advanced stages of disease in the irradiated group, including 89% with stages C and D1 (pT3N0 and pT1 to 3, N1 to 3), compared to 14% with stages C and D1 (pT3N0 and pT1 to 3, N1 to 3) in the nonirradiated group (p < 0.001). No difference in urinary continence was noted in the irradiated (94%) compared to the nonirradiated group (92%, p = 0.64). Of the patients who underwent bilateral nerve sparing prostatectomy 44% who received and 48% who did not receive radiation had recovered potency at 1 year (p = 0.76). Of those who underwent unilateral nerve sparing prostatectomy 10% who received and 33% who did not receive radiation had recovered potency at 1 year (p = 0.14). Using multivariate analysis patient age younger than 63 years and bilateral versus unilateral nerve sparing procedures were significant predictors of potency. CONCLUSIONS: Our retrospective study suggests that at 1 year after treatment moderate doses of postoperative radiotherapy did not have a significant impact on the recovery of urinary continence and potency after nerve sparing prostatectomy. However, longer followup is required to determine the impact of this radiation protocol on long-term preservation of potency after nerve sparing prostatectomy.

Combined Modality Therapy↗
PubMed1995

Is there always a role for radical prostatectomy in the treatment of localized prostate cancer?

The efficacy of radical prostatectomy on localized prostate cancer is well documented. However if a high risk for patients suffering from prostate cancer and effectiveness of treatment would be documented, the advantage of the therapy on the natural history of the disease must be demonstrated. Johansson et al. analyzed the natural history of 223 untreated localized prostate cancer with a mean follow up of 123 months. Only 8.5% of the patients died of prostate cancer. The 10 year disease specific survival rate was 86.8%. The progression free survival rate was 53.1%. Zincke et al. reported that the disease specific survival of the T1 T2 submitted to radical prostatectomy at 15 years was 93% and the survival free of disease was 70%. Our data on localized prostate cancer submitted to radical prostatectomy showed that the disease specific survival and the progression free survival after 5 years of follow-up were 99% and 85.7% respectively. Fleming, focusing on life expectancy, demonstrated that radical prostatectomy provides some benefit compared with watchful waiting for patients younger than 70 years. The greatest marginal benefits of treatment arise when we assume higher metastatic rates and higher treatment efficacy. In fact in this case, radical prostatectomy offers 3.5 years of improvement in quality of life adjusted survival in younger patients with moderately or poorly differentiated tumors. Radical prostatectomy can particularly benefit selected groups of patients with localized prostate cancer. The grade of differentiation has been shown to be the most powerful predictor in several series. DNA ploidy and tumor volume may be other reliable prognostic factors. Among all the parameters considered, the two with greatest effect in determining the outcome of treatment compared to watchful waiting were the rate of progression to metastatic disease in untreated patients and the estimated efficacy of treatment in reducing the metastatic rate.

Age Factors↗
PubMedDate not supplied

Average charges for a radical prostatectomy and a transurethral resection of the prostate (TURP): geographic variations, 1994.

In 1994 MetLife paid claims from group health policy insured for 1,004 radical prostatectomies and 1,597 transurethral resections of the prostate (TURPs). The total average hospital and physician charges were $18,680 and $7,600, respectively, with marked geographic variation evident for both procedures by area and state. The Pacific area led with a total charge of $20,790 for a radical prostatectomy, 11.3 percent above the U.S. average and the South Atlantic area reported the highest average TURP charges, $8,710 (14.6 percent above norm). For both surgeries, the East South Central area reported the lowest average total charge, 21.2 percent lower than the norm for a TURP and 30.9 percent lower than the national prostatectomy average. Charges 20 percent or more above the national average were reported in Illinois, California, Georgia and North Carolina for a TURP and in Illinois, California and Pennsylvania for a radical prostatectomy. Of the study states, Tennessee, Washington, Michigan and Oklahoma had charges 20 percent or more below the national average for a prostatectomy; Washington, Ohio, Tennessee, Alabama and Oregon each had average TURP charges 25 percent or more below the U.S. average. Physician fees differed by more than 95 percent between New York ($3,240) and Michigan ($1,660) for a TURP and by 113 percent between the doctors' charges for a prostatectomy in New York ($8,710) and those in Tennessee ($4,080). On average, patients remained in the hospital for 5.56 days for the radical procedure with lengths of stay ranging from 7.02 days in New York to 4.42 days in Missouri. TURP patients were in the hospital for an average of 3.66 days with Indiana patients staying the longest (5.58 days) and those in Oregon the shortest (2.29 days).

Cost Control↗
PubMed1996

[Radical transcoccygeal prostatectomy].

OBJECTIVE: A non randomized prospective study aimed at verifying the clinical outcome and pathological features of a group of patients submitted to transcoccygeal radical prostatectomy. METHODS: Radical transcoccygeal prostatectomy was carried out at our institution in 26 patients after laparoscopic (24 cases) or open surgical (2 cases) pelvic lymphadenectomy. Eighteen patients were selected if considered at risk for nodal metastases on the basis of preoperative staging (PSA > or = 20 ng/ml and/or Gleason score > 5), while the remaining 8 were affected by incidental prostate carcinoma. RESULTS: Intraoperative complications included rectal injury and massive blood los in one case (3.8%). Transitory leakage at the site of the urethrovesical anastomosis and urethrorectal fistula occurred postoperatively in two patients. The rate of positive surgical margins was 26.9%. The mean follow-up time was 27 months (range 3-39 months). Total urinary continence was obtained in 21 cases (80.8%), while 5 patients (19.2%) still require urinary pads. Four patients (15.4%) have experienced tumour recurrence evidenced only by elevated serum PSA levels. Local tumour recurrence with positive biopsy of urethrovesical junction was diagnosed in 3 patients (11.5%), while systemic tumour recurrence occurred in one case (3.8%). CONCLUSIONS: Radical transcoccygeal prostatectomy is a safe procedure for the surgical treatment of prostate cancer both from a clinical and pathological point of view. Operative complications, as well as pathological features and clinical outcome reported in this series of patients, must be related to selection criteria use in the majority of cases. The exact role of radical transcoccygeal prostatectomy in the clinical setting has yet to be defined. According to these preliminary results, radical transcoccygeal prostatectomy should be further investigated in the treatment of incidental carcinoma following TURP or suprapubic prostatectomy.

Adenocarcinoma↗
PubMed1998

Predictors of pathological stage before neoadjuvant androgen withdrawal therapy and radical prostatectomy. The Canadian Urologic Oncology Group.

PURPOSE: This prospective randomized trial was used to compare predictive factors for organ confined margin negative status after radical prostatectomy with and without a 3-month course of neoadjuvant androgen withdrawal therapy. MATERIALS AND METHODS: A total of 213 patients with localized adenocarcinoma of the prostate were randomized to radical prostatectomy with or without a 3-month course of 300 mg. neoadjuvant cyproterone acetate daily. Multivariate logistic regression analysis was used to determine significant predictors of organ confined margin negative status after radical prostatectomy in both groups. Parameters evaluated included baseline prostate specific antigen (PSA 4 or less, 4.1 to 10, greater than 10 ng./ml.), clinical stage (T2c versus T2b or less), biopsy Gleason score and percentage of surface area of biopsies involved with cancer. The multivariate analysis was repeated with PSA density and the natural logarithm of PSA to optimize the model. RESULTS: In the radical prostatectomy alone arm a model incorporating only PSA density was the best predictor of organ confined margin negative status. In the neoadjuvant androgen withdrawal therapy arm a model incorporating biopsy Gleason score, PSA density and clinical stage was the best predictor. CONCLUSIONS: The conventional predictors of pathology at radical prostatectomy, biopsy Gleason score, PSA density and clinical stage retain significance as predictors in patients treated with a 3-month course of neoadjuvant androgen withdrawal therapy before radical prostatectomy.

Adenocarcinoma↗
PubMed1998

Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis.

OBJECTIVES: To evaluate the relative efficacy of brachytherapy to radical prostatectomy, we compared biochemical progression rates from a published series of men who underwent iodine 125 (125I) interstitial radiotherapy for localized prostate cancer to a similar group of men who underwent anatomic radical prostatectomy using appropriate end points. METHODS: Seventy-six men who underwent anatomic radical prostatectomy between 1988 and 1990 were carefully matched for Gleason score and clinical stage to a recently reported contemporary series of patients treated at another institution with 125I brachytherapy without adjuvant treatment. The definition of biochemical progression was a serum PSA level greater than 0.2 ng/mL after anatomic radical prostatectomy and greater than 0.5 ng/mL for brachytherapy-treated patients. RESULTS: The 7-year actuarial PSA progression-free survival following anatomic radical prostatectomy was 97.8% (95% confidence interval [CI], 85.6% to 99.7%) for this group of men selected to match the brachytherapy group, compared to 79% (95% CI not published) for men treated with 125I interstitial radiotherapy. CONCLUSIONS: Using comparative end points for biochemical-free progression, failure rates may be higher following 125I interstitial radiotherapy compared to anatomic radical prostatectomy. These data provide a better comparison of biochemical progression than previously published studies and emphasize the need for caution in interpreting the relative efficacy of brachytherapy in controlling localized prostate cancer.

Adult↗
PubMed1998

[The treatment of locally advanced (T3) prostatic carcinoma using radical prostatectomy or radiotherapy. A review].

In the Netherlands 16% of all newly diagnosed prostatic carcinomas are already locally advanced (TNM-system: T3), which means that the tumor spreads beyond the prostatic capsule, or grows into the seminal vesicles. The pre-operative clinical staging is not very reliable when local tumor extension is concerned: the sensitivity for detecting extracapsular extension is 67% for digital rectal examination and 58% for transrectal ultrasonography of the prostate. In 50% of clinically locally confined tumors spread outside the prostate is found; and in 18% of the T3 tumors the tumor is confined to the prostate. In most clinics patients with locally advanced tumors are not considered to be candidates for radical prostatectomy, because the margins are small, due to anatomical factors. Progression and survival reported in the research literature for patients treated by radical prostatectomy for T3 prostate cancer are, however, at least equal to those treated with radiotherapy, which is considered the standard treatment for this stage. The average 10-year percentages for progression and survival of T3 prostate cancer patients treated by radical prostatectomy (or radiotherapy) are: clinical progression: 40% (radiotherapy: 61%); local recurrence 18% (35%); biochemical progression: 60% (93%); survival: 63% (39%); and prostate cancer specific survival: 78% (44%). These success-rates can not be compared directly, because of differences in physical condition and staging between the groups, which favor the radical prostatectomy group. There is, however, a subgroup of patients with undifferentiated carcinoma which shows high progression rates following radical prostatectomy; these patients need adjuvant hormonal treatment, or should be given a different therapy. The role of adjuvant radiotherapy following radical prostatectomy is still a matter of debate, as is the administration of neoadjuvant hormonal therapy. For the moment these therapies should only be given in clinical trials.

Aged↗
PubMed1998

Collagen injection therapy for post-prostatectomy incontinence.

PURPOSE: Post-prostatectomy incontinence has an incidence of 5 to 12% and greatly affects quality of life. Since the approval of glutaraldehyde cross-linked collagen there is a renewed interest in injectable urethral bulking agents. We investigated the long-term efficacy and prognostic criteria for transurethral collagen injection therapy for men with post-prostatectomy incontinence. MATERIALS AND METHODS: From November 1993 to May 1995, 62 men with post-prostatectomy incontinence (54 after radical prostatectomy and 8 after transurethral resection of the prostate) were treated with collagen via a transurethral approach. Median followup was 29.0 months from the date of the last injection procedure. RESULTS: Social continence was defined as dry or minimal leakage requiring at most 1 pad daily with activity. Of 62 patients 38.7% achieved social continence and 8.1% became totally dry. The success rate was 35.2 for radical prostatectomy versus 62.5% for transurethral prostatic resection patients. Of the patients who achieved social continence with at least 1-year followup 23 (60.9%) remained so with no further treatment. At 2-year followup 21 patients (42.8%) maintained social continence. The success rate was 27.3% for those who wore a penile clamp or condom catheter before treatment (3 of 11 patients), and only 21.4% for those who underwent transurethral incision of a bladder neck contracture (3 of 14). A median of 4 injection procedures and 20.0 ml. collagen were required to achieve social continence. CONCLUSIONS: Transurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more conservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethral incision of a bladder neck contracture are unlikely to respond well to this treatment.

Activities of Daily Living↗
PubMedDate not supplied

Salvage radiotherapy for biochemical and clinical failures following radical prostatectomy.

PURPOSE: The proportion of prostate cancer patients undergoing radical prostatectomy has increased over the past 10 to 15 years. It is conceivable that a corresponding increase in local tumor recurrences after prostatectomies will be observed. The role of salvage radiotherapy is presently unclear. In this study, the results of salvage radiotherapy for patients with biochemical evidence of local recurrence, as evidenced from rising prostate-specific antigen (PSA) levels, after radical prostatectomy at UCLA Medical Center and the West Los Angeles Veterans Administration Medical Center are described. PATIENTS AND METHODS: Between 1990 and 1997, 69 patients were diagnosed with presumed local tumor recurrence after radical prostatectomy. Of these patients, 60 patients were referred to radiotherapy for salvage treatments. Tumor recurrence was detected biochemically, with or without a palpable nodule on digital rectal examination, and a metastatic workup revealing no evidence of extrapelvic disease. Biochemical failure after salvage radiotherapy was defined as two consecutive rises in serum PSA level after a PSA nadir or an absence of a PSA nadir after radiation treatments, as was earlier defined at the ASTRO Consensus Panel on PSA Guidelines. Patients referred for adjuvant postoperative radiation treatment and patients with metastatic disease at presentation were excluded from the study. Patients were treated with a four-field approach (anteroposterior/posteroanterior and opposing laterals) to a median dose of 64.8 Gy in 1.8-Gy fractions. Follow-up evaluations included serum PSA level and digital rectal examination every 3 to 6 months. RESULTS: At last follow-up (mean follow-up, 36 months after salvage radiotherapy), 40 of 60 patients (67%) were biochemically free of disease. Thirty of 60 patients (50%) had undetectable PSA levels, and 55 of 60 (92%) had achieved some initial decrease after salvage radiation treatments. Three-year and 5-year actuarial biochemical disease-free survival was 63% and 55%, respectively. Of the 20 patients with biochemical failure after salvage radiation therapy, 10 patients (50%) developed distant metastases, and two (10%) patients were found to have persistent local disease. The mean time to biochemical relapse after salvage radiotherapy was 10 months, and the mean time to distant metastasis after salvage radiotherapy was 20 months. Evaluation of the remaining eight biochemical failures (43%) revealed no evidence of local disease progression or distant metastasis to date. Univariate and multivariate analyses revealed that both PSA > 1.0 ng/mL at the time of salvage radiotherapy and perineural invasion significant prognosticators for biochemical relapse after salvage radiotherapy. Likewise, both univariate and multivariate analyses revealed that prognosticators for distant metastasis included seminal vesicle invasion and perineural invasion. DISCUSSION: Salvage radiation therapy is a viable option for post prostatectomy local tumor recurrences. Of the patients who fail biochemically after salvage radiotherapy, 50% were eventually found to have distant metastases. In addition, biopsy-proven local recurrence after-prostatectomy was found not to confer an adverse outcome after salvage radiotherapy.

Analysis of Variance↗
PubMed1998

Radical prostatectomy specimens among Medicare patients in New York State: a review of pathologists' reports.

CONTEXT: Gross and microscopic pathologic examinations of radical prostatectomy specimens should result in reports that contain comprehensive information. Such information is important for facilitating adjuvant therapy decisions, assessing treatment interventions, providing patients and their families with estimates of prognosis, and in analyzing clinical outcomes. An important element of the information in radical prostatectomy specimen reports is the tumor status of margins, which is essential for staging. OBJECTIVES: The purposes of this study were to analyze the gross and microscopic examinations documented in a sample of radical prostatectomy reports and, by doing so, to determine the comprehensiveness of these reports. METHODS: The pathology reports from 414 charts of male Medicare patients aged 70 years and older who underwent radical prostatectomy in the 3-year period between 1991 and 1993 in New York State were examined. This group included all patients 75 years and older and a random sample of the 1266 patients aged 70 to 74 years who had undergone the procedure during the 3-year time frame. A protocol was used for recording general information from each pathology report as well as data relevant to gross and microscopic examinations. RESULTS: The results of this study demonstrated an absence of uniformity in reporting protocols, as well as documentation problems in those protocols used. Important information concerning both the gross and microscopic examinations was frequently absent. An important finding of the study was the high level (94.9%) of reporting on the microscopic status of prostate gland margins, which permitted an accurate assessment of margin positivity. Among those cases for which margin status was reported, 54% were found to be tumor positive. This is a significant finding in that it has implications for TNM staging. Such patients have an increased risk of disease progression and have been shown to have the same 5-year mortality rate as patients who have not been treated surgically. CONCLUSIONS: The study demonstrated a lack of uniformity in the pathology protocols used to describe radical prostatectomy specimens and the frequent absence of important gross and microscopic information. The results of this study also demonstrated a high rate (54%) of margin positivity among elderly men undergoing radical prostatectomy. Based on the results of this study, there is a need for closer attention to the issue of margin positivity. There is also a need for considering the usefulness of standardized reporting that includes elements with proven, putative, or prognostic value.

Adenocarcinoma↗
PubMed1998

[Urodynamics of urinary incontinence post radical prostatectomy].

OBJECTIVE: To determine the urodynamic characteristics of urinary incontinence after radical retropubic prostatectomy. METHODS: We conducted a clinical and urodynamic study on 25 patients who had undergone radical retropubic prostatectomy due to localized prostate adenocarcinoma. RESULTS: 68% of the patients completely recovered urinary continence. The maximum rate of urinary continence recovery was found between the third and fourth month postprostatectomy. A relationship was demonstrated between preoperative hormone blockade, duration of the surgery and urinary continence. Videocystography demonstrated an incompetent proximal continence mechanism in all radical prostatectomy patients. All incontinent patients presented stress urinary incontinence. Denervation potentials of the periurethral sphincter was demonstrated by electromyography in 80% of incontinent patients. These potentials were not present in the continent patients. Reinnervation potentials were present in 50% of the continent patients and in 20% of the incontinent patients (significant differences). No relationship was found between other urodynamic data and post-radical prostatectomy urinary incontinence. CONCLUSIONS: The surgical difficulty influences the preservation of urinary continence. A high percentage of patients submitted to radical prostatectomy recover urinary continence with time. Urinary incontinence following radical prostatectomy is based on the distal sphincteric mechanism. Patients who remain incontinent four months postoperatively and with electromyographically demonstrated denervation potentials of the periurethral sphincter can be considered to be candidates for treatment of incontinence without waiting any further.

Aged↗
PubMed1999

A feasibility study of cryotherapy followed by radical prostatectomy for locally advanced prostate cancer.

PURPOSE: There has been a significant shift toward multimodality therapy to try to eradicate extracapsular disease better in patients with locally advanced prostate cancer. We assess the feasibility and complications of initial cryotherapy followed by radical prostatectomy, and evaluate the frequency and location of viable benign and malignant prostate tissue and positive surgical margins after this treatment combination. MATERIALS AND METHODS: A total of 12 patients with clinical stage T3 cancer or clinical stages T1c to T2, Gleason score 8 to 10 cancer on the initial biopsy were treated with initial cryotherapy followed by open surgical exploration 2 to 8 days later. If pelvic lymph nodes were negative, radical prostatectomy was performed. Prostate specific antigen was measured approximately every 3 months postoperatively, and complications were assessed by retrospective chart review and a quality of life survey. RESULTS: Radical prostatectomy was aborted in 5 patients with positive pelvic lymph nodes. Of the 7 patients who underwent prostatectomy 4 had no residual prostate cancer in the specimen (pathological stage pT0 disease). All 7 of these patients had focal areas of viable normal prostate glands. Only 1 of the 7 patients had a positive surgical margin and biochemical failure (mean followup 22.6 months). The main complications of cryotherapy followed by radical prostatectomy were urinary incontinence and impotence. CONCLUSIONS: Neoadjuvant cryotherapy achieved complete tumor destruction in 4 of 7 patients with locally advanced prostate cancer. Cryotherapy followed by radical prostatectomy was associated with substantial morbidity, mainly in terms of urinary incontinence.

Combined Modality Therapy↗