Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PROSTATECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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

At least 631 records · Page 35Linked to original sources
PubMed1987

Post-prostatectomy incontinence: the influence of bladder dysfunction.

The urodynamic studies of 38 patients referred for evaluation of incontinence after prostatectomy were reviewed. Only 15 patients (39.5 per cent) had pure sphincteric insufficiency as the sole cause of the incontinence. Of the 38 patients 16 (42 per cent) had sphincteric insufficiency combined with a significant component of bladder dysfunction (detrusor instability and/or low bladder wall compliance) as the cause of the incontinence. A total of 7 patients (18.5 per cent) had no evidence of sphincteric insufficiency but they had post-prostatectomy incontinence solely caused by detrusor instability and/or low bladder wall compliance. Of the patients referred for post-prostatectomy incontinence 60.5 per cent had bladder dysfunction as a major factor in the incontinence, which emphasizes the need for comprehensive urodynamic evaluation before treatment is recommended. Of 26 patients whose treatment was based on urodynamic findings and who were available for followup 23 (88 per cent) were adequately continent after treatment, with 35 per cent responding to pharmacological treatment alone and 54 per cent requiring placement of an artificial urinary sphincter with or without associated pharmacological therapy. The potential role of bladder dysfunction as a causative factor in post-prostatectomy incontinence must be considered to optimize the results of treatment and to avoid an unnecessary operation.

Aged↗
PubMed1987

Radical prostatectomy for carcinoma in men more than 69 years old.

Between 1974 and 1986, 193 men with prostatic cancer were treated with bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. Of the 193 patients 65 were 70 years or older (5 were 78 years old). Of the 32 men in this series who underwent a potency-sparing modification of the radical prostatectomy 7 were 70 years or older, the oldest being 77 years. A comparison of the morbidity and mortality of the 65 men in the older group with the 128 men in the group less than 70 years old revealed no significant difference. Long-term followup data demonstrated 57 men in the older age group to be well with no evidence of disease, with 10 in that group well with no evidence of disease greater than 5 years after the radical prostatectomy. We recommend radical prostatectomy for patients with clinically localized prostatic carcinoma whose general health suggests a 10-year or greater probable life expectancy, aside from tumor.

Aged↗
PubMed1986

Short-term prophylactic antibiotics in patients undergoing prostatectomy: report of a double-blind randomized trial with 2 intravenous doses of cefotaxime.

The effect of short-term antibiotic prophylaxis on postoperative infection with 2 injections of cefotaxime begun preoperatively was evaluated in a double-blind, randomized, placebo-controlled trial at 1 center on 181 patients with preoperative sterile urine undergoing transurethral resection (90) or open prostatectomy (91). Antibiotic prophylaxis reduced the number of urinary infections significantly in both groups without altering the level of resistant pathogens. Cefotaxime lowered the incidence of postoperative infection in the early postoperative period from 30 to 4 per cent in the transurethral resection group and from 46 to 4.5 per cent in the open prostatectomy group. A significant difference was found between the 2 treatment groups in the incidence of perioperative bacteremia and postoperative fever. Among the patients undergoing an open prostatectomy a reduced rate of wound infection and a shorter duration of hospital stay were witnessed in the treated group. Thus, short-term chemoprophylaxis by cefotaxime is of benefit in reducing morbidity and hospital cost for prostatectomy by either procedure.

Cefotaxime↗
PubMed1984

Total prostatectomy for localized prostatic cancer.

Several treatment options currently are available for the patient with clinically localized carcinoma of the prostate and each has its proponents. Comparison of results between institutions becomes necessary to determine the relative value of these treatments, keeping in mind the absence of a suitable control group in any series. Such inter-institutional treatment comparisons are possible only if the patient compositions are similar in terms of age, grade and extent of disease. Comparisons of patients with stage B disease frequently are made because most urologists agree that these patients have palpable disease confined to the prostate and no evidence of metastasis. At our clinic willing patients with clinically localized adenocarcinoma of the prostate who have an expected 15-year survival are treated preferentially with total prostatectomy. We summarize our experience with total prostatectomy in 215 consecutive patients, including 213 who were available for followup. There were 16 patients with clinical stage A, 195 with clinical stage B and 2 with clinical stage C disease. Of these patients 207 underwent radical perineal prostatectomy and there were no operative deaths. Patients did not receive adjuvant hormonal therapy unless disease recurred. Of the 110 patients who have undergone the operation within the last 5 years 98 per cent are alive. Actual survival and survival free of disease, respectively, for the entire series were 55 and 48 per cent at 15 years, 75 and 67 per cent at 10 years, and 94 and 86 per cent at 5 years, compared to 55 and 48, 74 and 67, and 95 and 90 per cent, respectively, for the 195 patients with clinical stage B disease. We believe these results demonstrate that in terms of local control of the disease, over-all survival and survival free of disease total prostatectomy remains the optimal treatment for patients with clinically localized carcinoma of the prostate.

Adenocarcinoma↗
PubMed2000

Laparoscopic radical prostatectomy: preliminary results.

OBJECTIVES: To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures. METHODS: Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first 10 patients, we performed the vesicourethral reconstruction with interrupted sutures; in the remaining 33 patients, we performed it with two hemicircumferential running sutures. The specimen was removed through the umbilical port site. RESULTS: Once the developmental phase with the first 10 patients was concluded, the median operating time was 4.3 hours without pelvic lymphadenectomy, and the median postoperative bladder catheterization was 4 days. Two (4.7%) of 43 patients underwent transfusion. Twelve patients (27.9%) had positive surgical margins; all patients had a postoperative prostate-specific antigen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 patient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, and four stated they had had sexual intercourse. CONCLUSIONS: Laparoscopic radical prostatectomy has evolved to a fully standardized and reproducible procedure. The short-term oncologic and functional efficacy rates are equivalent to those for open surgery. The operating time is reasonable once the learning curve is over, and postoperative morbidity is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery.

Aged↗
PubMed2000

Correlation of preoperative plasma IGF-I levels with pathologic parameters and progression in patients undergoing radical prostatectomy.

OBJECTIVES: To test whether preoperative insulin-like growth factor (IGF)-I levels could predict pathologic stage and prognosis of prostate cancer in patients undergoing radical prostatectomy. METHODS: The study group consisted of 120 consecutive patients who underwent radical prostatectomy for clinically localized prostate cancer. Preoperative plasma IGF-I levels were measured using the DSL-IGF-I Elisa assay. Surgically removed prostate specimens were analyzed pathologically, using a whole-mount step-section technique. Preoperative plasma IGF-I levels were compared with final pathologic parameters and with prostate-specific antigen (PSA) progression-free survival. Preoperative IGF-I levels in this cohort were also compared with IGF-I levels measured in 20 healthy men without any cancer and in 10 men with untreated, metastatic prostate cancer. RESULTS: Plasma IGF-I levels predicted neither organ-confined disease (P = 0.5611) nor the risk of PSA progression (P = 0.8125) at a median follow-up of 48.6 months after prostatectomy. Furthermore, IGF-I levels did not correlate with preoperative PSA level (P = 0. 2811) or final Gleason score (P = 0.4906). IGF-I levels in radical prostatectomy patients were not significantly higher than those in healthy subjects or in patients with metastatic disease (mean 156.7 +/- 66 ng/mL, 148.6 +/- 49 ng/mL, and 148.6 +/- 93 ng/mL, respectively; P = 0.8442). CONCLUSIONS: Circulating IGF-I levels may predict the future risk of developing prostate cancer, but our study found no association with other established markers of biologically aggressive disease or with disease progression in patients with clinically localized prostate cancer.

Adenocarcinoma↗
PubMed2000

Sildenafil in the treatment of erectile dysfunction after radical prostatectomy.

OBJECTIVES: To evaluate the efficacy of sildenafil for the treatment of erectile dysfunction after radical prostatectomy and to determine whether age, preservation of the neurovascular bundles (NVBs), or the interval between surgery and the initiation of sildenafil therapy influences the response to sildenafil. METHODS: We began this study in April 1998, immediately after the Food and Drug Administration approved sildenafil. We surveyed 170 men who had undergone radical retropubic prostatectomy, had not recovered natural erections sufficient for intercourse, and subsequently received sildenafil between 3 and 24 months postoperatively. The data were collected through a confidential mail survey conducted by a clinical nurse. The men used a dose of 50 mg sildenafil and increased this to 100 mg if they did not obtain an adequate response. RESULTS: In the 120 men who began taking sildenafil at least 12 months after surgery, the overall response rate was 29%. Results varied markedly by patient age and number of NVBs preserved. In men younger than 55 years in whom both NVBs had been preserved, the response rate was 80%. In contrast, no patient older than 55 years in whom only one NVB had been preserved reported an adequate response. Regardless of age, no patient in whom both NVBs had been excised reported success with sildenafil. Of the 50 patients who began taking sildenafil less than 9 months after surgery and who had not recovered natural sexual function, none reported erections adequate for intercourse using sildenafil. CONCLUSIONS: Sildenafil is an effective treatment for men with erectile dysfunction after radical retropubic prostatectomy, particularly in younger men in whom both NVBs have been preserved. It is ineffective in men in whom both NVBs have been excised, and it is also ineffective in older men in whom only one NVB has been preserved. Sildenafil appears ineffective in the first 9 months after prostatectomy.

Age Factors↗
PubMed2000

Additional treatments and reimbursement rates associated with prostate cancer treatment for patients undergoing radical prostatectomy, interstitial brachytherapy, and external beam radiotherapy.

OBJECTIVES: To define patterns of treatment among contemporary patients undergoing radical prostatectomy, interstitial radiation, and external beam radiation for prostate cancer. METHODS: We analyzed 291 consecutive patients (Stage T1-T3NXM0) who underwent definitive local treatment for prostate cancer with radical prostatectomy, interstitial seed implantation, or external beam radiation. Patients were stratified into three risk groups based on clinical T stage, serum prostate-specific antigen level at diagnosis, and biopsy Gleason score. The frequency of additional treatments, including androgen deprivation and external beam radiation, given within 3 months of initial local therapy was assessed. Patterns of care were compared and adjusted for risk. RESULTS: Of the 291 patients, 107 (36. 8%) underwent radical prostatectomy, 94 (32.3%) underwent interstitial seed implantation, and 90 (30.9%) underwent external beam radiation. Use of combination therapy differed significantly according to the type of initial local treatment and risk category. No patient in the low-risk group received combination therapy. For patients in the intermediate and high-risk groups, the frequency of combination therapy was significantly lower in the radical prostatectomy group when compared with either the interstitial seed implantation (P <0.001 and P <0.02, respectively) or external beam radiation group (P <0.001 and P <0.001, respectively). CONCLUSIONS: There are significant differences in resource utilization for contemporary patients undergoing definitive local therapy for prostate cancer. These differences may have a significant effect on treatment cost and morbidity, and they will likely make short-term comparisons between different treatment modalities difficult because of the high use of androgen deprivation in men treated with radiation therapy.

Brachytherapy↗
PubMed2000

A positive caver map response poorly predicts recovery of potency after radical prostatectomy.

OBJECTIVES: To determine whether preservation of the neurovascular bundles (NVBs), defined by a positive CaverMap response, correlates with the recovery of potency after radical prostatectomy. METHODS: We studied a group of 60 men who were potent preoperatively who underwent radical retropubic prostatectomy by one surgeon. The CaverMap was used after removal of the prostate to assess the integrity of the NVBs. Postoperative potency was assessed by a postal questionnaire and telephone interview, administered independently of the treating surgeon. Men were considered potent if they reported postoperative erections consistently sufficient for vaginal penetration with or without the use of sildenafil. RESULTS: The mean patient age was 59 years, and the median follow-up was 365 days. A positive CaverMap response was obtained in 73 (77%) of the 95 NVBs tested. The overall potency rate was 18%. No patients with a bilateral negative CaverMap response were potent, and 2 (22%) of 9 with a unilateral CaverMap response (negative versus unilateral response, P = 0.46) and 6 (27%) of 22 with bilateral CaverMap responses (negative versus bilateral response, P = 0.32) were potent. CONCLUSIONS: A positive CaverMap response, suggesting that a successful nerve-sparing prostatectomy had been performed, was obtained in 77% of the NVBs tested. Nevertheless, with a median follow-up of 12 months, most patients with a positive CaverMap response remained impotent. This suggests that other factors are critical to the recovery of sexual function after radical prostatectomy.

Diagnostic Techniques, Neurological↗
PubMed2001

Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable.

OBJECTIVES: To determine the feasibility and desirability of removing the urinary catheter 7 days after radical retropubic prostatectomy. METHODS: Between February 28, 2000 and October 5, 2000, 184 men underwent radical retropubic prostatectomy by a single surgeon. Of these men, 97% underwent gravity cystography under fluoroscopic control on postoperative day (POD) 7. The indwelling urinary catheter was removed on POD 7 if no evidence of extravasation was observed on cystography. Patients completed a self-administered questionnaire at the time of catheter removal to capture the degree of bother from incisional pain and the indwelling urinary catheter during the recovery period. The level of urinary continence was determined at 3 months after radical retropubic prostatectomy. RESULTS: One hundred thirty-five of the cystograms (75%) had no evidence of extravasation. The indwelling catheters were removed in 130 (97%) of 135 cases. The body weight, surgical specimen weight, presence or absence of intraoperative anastomotic extravasation, volume of pelvic drainage recorded from the Hemovac drain, and creatinine level of the pelvic drainage fluids did not predict the finding of extravasation on the POD 7 cystogram. Fifteen percent of the men whose catheters were removed on POD 7 developed acute urinary retention. At 3 months, 72% of men required no or a single protective pad, and 87% indicated they experienced no or slight bother from incontinence. These continence outcomes are comparable with a historical control group by the same surgeon who underwent catheter removal on POD 14. Forty-five percent of the men reported the catheter caused moderate to severe bother, compared with only 19% of men who indicated moderate to severe bother from incisional pain. In retrospect, 95.6% of men indicated willingness to undergo cystography on POD 7 with the intent of early catheter removal. CONCLUSIONS: The results of our study suggest that most men will have no extravasation on a cystogram performed on POD 7 and that removing the catheter at this time in these cases does not increase the risk of complications or compromise overall urinary continence. The urinary catheter is a significant bother and limits physical activity during the postoperative period. Cystography and early removal of the catheter is both feasible and desirable and should be offered to men after radical retropubic prostatectomy.

Catheters, Indwelling↗
PubMed2002

Three-year follow-up of laser prostatectomy versus transurethral resection of the prostate in men with benign prostatic hyperplasia.

OBJECTIVES: To present our 3-year data comparing laser prostatectomy and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Laser prostatectomy was one of the first new minimally invasive treatment modalities for BPH, and few reports of the long-term results of this treatment regimen have been published. METHODS: One hundred men with BPH in whom medical therapy had failed were randomized to undergo either laser prostatectomy or TURP. Preoperative measurements included American Urologic Association symptom score, prostate-specific antigen, uroflowmetry, and transrectal ultrasonography (TRUS). Laser prostatectomy was performed using the potassium titanyl-phosphate/neodynium:yttrium aluminum-garnet laser. TURP was performed in a standard manner with video monitoring. Patients were seen in follow-up at 1, 3, 6, and 12 months and every 12 months thereafter, with the following data obtained: symptom score, peak urinary flow rate, prostate-specific antigen level, and TRUS volume. RESULTS: A total of 100 patients were entered into the study, with 50 patients in each treatment group. The mean age was 68.2 years (range 45 to 90) for the laser patients and 67.4 years (range 54 to 82) for the TURP group. The mean symptom score decreased from 22.0 to 9.9 at 36 months of follow-up for the laser patients compared with 21.2 to 7.7 for the TURP patients. The mean peak flow rate increased from 8.2 to 12.3 mL/s at 36 months for the laser group with a similar increase from 7.3 to 12.8 mL/s for the TURP patients. The mean TRUS volume for the laser patients decreased from 33.9 to 32.9 cm3 at 36 months compared with a mean TRUS volume of 29.6 cm3 preoperatively for the TURP patients that decreased to 26.3 cm3 at 36 months. CONCLUSIONS: At 36 to 72 months of follow-up, the durability of results achieved by the patients in the laser cohort was similar to that for patients undergoing TURP.

Aged↗
PubMed2002

Salvage radiotherapy for rising or persistent PSA after radical prostatectomy.

OBJECTIVES: To assess the effectiveness of salvage radiotherapy (RT) for a persistent or rising prostate-specific antigen (PSA) level after radical prostatectomy, and to identify the pretreatment factors that may predict for patients likely to benefit from this treatment. METHODS: Seventy-three consecutive patients were treated during a 10-year period (1989 to 1999) with RT after radical prostatectomy. Twelve patients were excluded from analysis because of either an undetectable PSA level before RT or lack of follow-up data. No patients had clinical or radiographic evidence of distant disease. An undetectable PSA level (less than 0.1 ng/mL) was required to be considered disease free. RESULTS: The median PSA level before RT was 0.8 ng/mL (range 0.1 to 63). The median radiation dose prescribed was 66.6 Gy. The actuarial PSA-free survival rate at 4 years was 39%. Failure was uncommon in patients followed up beyond 4 years. Univariate analysis revealed that a pre-RT PSA level of less than 1.0 ng/mL (P = 0.001), Gleason score less than 8 (P = 0.003), and achievement of an undetectable PSA level after prostatectomy (P = 0.018) were significant predictors of improved disease-free survival. On multivariate analysis, both a pre-RT PSA level of less than 1.0 ng/mL and a Gleason score less than 8 maintained statistical significance. CONCLUSIONS: Salvage RT provides a reasonable chance of intermediate-term disease-free survival in patients with PSA persistence or relapse after radical prostatectomy. Patients with a higher PSA level (greater than 1 ng/mL) and Gleason score of 8 or more are less likely to benefit from this treatment, and improved therapies are needed for this subset of patients. Patients should be referred promptly for salvage RT after detection of relapse.

Analysis of Variance↗
PubMed2003

Tamsulosin reduces the incidence of acute urinary retention following early removal of the urinary catheter after radical retropubic prostatectomy.

OBJECTIVES: To determine the efficacy of tamsulosin in preventing acute urinary retention following early catheter removal after radical retropubic prostatectomy. METHODS: Between February 2000 and October 2000, cystography was performed on postoperative day 7 after radical retropubic prostatectomy by a single surgeon (group 1). Between September 2001 and August 2002, cystography was performed on postoperative day 8 after radical retropubic prostatectomy by the same surgeon (group 2). The protocol for performing cystography and assessment of extravasation was similar for both groups. Tamsulosin 0.4 mg was administered 3 days before and 4 days after cystography for all men in group 2. RESULTS: Of 179 cystograms in group 1, 135 (75%) revealed no extravasation, and the catheters were removed in 130 of these cases. Of 246 cystograms in group 2, 230 (93.5%) revealed no extravasation, and the catheters were removed in 229 of these cases. A significantly greater proportion of men in group 2 had no extravasation (P = 0.0007). The incidence of acute urinary retention in groups 1 and 2 was 10% and 2.6%, respectively (P = 0.0018). The incidence of anastomotic stricture was not significantly different between the two groups. CONCLUSIONS: Our data strongly suggest that tamsulosin significantly reduces the risk of acute urinary retention after attempts at early catheter removal following radical retropubic prostatectomy. Therefore, we recommend administering a 7-day course of tamsulosin therapy when attempting to remove the urinary catheter before postoperative day 8.

Acute Disease↗
PubMed2003

Prospective evaluation of pain medication requirements and recovery after radical perineal prostatectomy.

OBJECTIVES: To perform a study to quantify the variables relating to postoperative pain, activity, and gastrointestinal function after radical perineal prostatectomy to allow comparisons with alternative treatments. METHODS: Ninety-eight consecutive radical perineal prostatectomy candidates between January 2001 and December 2001 with clinically localized prostate cancer were prospectively evaluated. The time to tolerate solid food, time to unassisted ambulation, postoperative pain levels (analog pain scale of 1 to 10), and perioperative analgesic requirements (in morphine equivalents) were selected as the analysis endpoints and correlated with preoperative (age, American Society of Anesthesiology class, body mass index, and serum prostate-specific antigen level), intraoperative (node dissection, operating room time, and estimated blood loss), and postoperative (Gleason score, tumor stage, and lower extremity neurapraxia) patient variables. RESULTS: The mean time to tolerate solid food and unassisted ambulation was 21.2 +/- 1.4 and 22.4 +/- 0.8 hours, respectively; 25.5% of patients experienced transient lower extremity neurapraxia, which was associated with longer operative times (P = 0.001). In a multivariate regression analysis, lymph node dissection correlated with both a prolonged time to tolerate solid food (P = 0.002) and unassisted ambulation (P = 0.001) and neurapraxia with an extended time to unassisted ambulation (P = 0.018). The narcotic requirements were greatest on postoperative day 1, totaling 31.7 +/- 3.0 morphine equivalents, of which 90.5% +/- 3.1% were met with oral analgesics. The average maximal pain scores were highest the first week after discharge (4.7 +/- 0.3), yet approached baseline levels by 4 weeks (1.7 +/- 0.2) after surgery at which time no patient required any pain medication. CONCLUSIONS: Modern radical perineal prostatectomy offers a favorable outcome profile with early patient recovery and low narcotic requirements. A future prospective study should directly compare radical perineal, retropubic, and laparoscopic prostatectomy to document whether the latter offers any advantages with respect to these outcome parameters.

Adult↗
PubMed1994

Vesicourethral healing following radical prostatectomy: is it related to surgical approach?

OBJECTIVES: To explore how the occurrence of vesicourethral anastomotic strictures (bladder neck contractures [BNC]) following radical prostatectomy was dependent on these variables: postoperative urine extravasation, type of anastomosis, size of prostate, and surgical approach. METHODS: We retrospectively reviewed 143 cases over 36 months for the occurrence of early BNC (6 to 12 months follow-up). Voiding cystourethrograms (VCUC) were performed in all patients at 3 weeks. Radical retropubic prostatectomy (RRP) with direct anastomosis was performed in 93 cases, RRP and Vest anastomosis in 35 cases, and radical perineal prostatectomy (RPP) in 15 cases. RESULTS: The overall incidence of extravasation was 14.1%. Procedure-specific rates of incidence of extravasation were RPP 33.3%, RRP 18.1%, and radical retropubic with Vest anastomosis (Vest) 6.1%. Mean prostate weight was not significantly different between patients with or without extravasation. The anastomotic site was classified as being irregular (plicated) or smooth in appearance on the VCUG images. An irregular appearance was noted among 81% of the RRP, 42.4% of the Vest, and 40% of the RPP. Bladder neck contractures occurred in 29% of patients with Vest anastomosis, 14.1% with RRP, and none of the patients undergoing RPP. Only 1 patient in both the Vest and RRP group who experienced BNC was noted to have extravasation on VCUG at 3 weeks. CONCLUSIONS: We have noted that the type of anastomosis (Vest traction sutures) significantly increases the likelihood of early bladder neck contracture following radical prostatectomy. The presence of contrast extravasation on the postoperative VCUG study (implying urinary extravasation) did not influence the formation of an anastomotic stricture as long as patients were maintained with catheter drainage until resolution of extravasation. The appearance of the newly constructed bladder neck on the postoperative VCUG image was not predictive of a subsequent contracture.

Anastomosis, Surgical↗
PubMed1996

Limited efficacy of preoperative computed tomographic scanning for the evaluation of lymph node metastasis in patients before radical prostatectomy.

OBJECTIVES: To evaluate the efficacy of preoperative computed tomographic (CT) scanning in patients with presumed localized prostatectomy prior to radical retropubic prostatectomy. METHODS: A retrospective study of 173 consecutive patients believed to be candidates for radical retropubic prostatectomy who underwent preoperative CT scanning regardless of preoperative prostate-specific antigen (PSA) value, clinical stage, or Gleason grade was undertaken. All patients underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection or aspiration needle biopsy of abnormal nodes on CT scanning. RESULTS: One hundred sixty-five of 173 patients (95.4%) were believed to have normal CT scans preoperatively. Of these 165 patients, 156 (94.5%) were found to have negative lymph nodes confirmed histologically at the time of lymphadenectomy. Nine patients (5.5%) were found to have lymph node metastases confirmed histologically, despite a negative CT scan. Computed tomographic scanning understaged 9 of 12 (75%) patients with proven metastases. Incidental abdominal pathology of clinical significance was documented in 4 patients (2.3%), including 2 with renal cell cancers, 1 with colon cancer, and 1 with a large (8 cm) abdominal aortic aneurysm. Prostate-specific antigen levels in patients with metastatic lymph nodes ranged from 0.7 to 130 ng/mL (Hybritech Tandem assay), with a mean level of 42 ng/mL. Although 9 of 33 patients (27.3%) with PSA levels greater than 25 ng/mL had node metastases, only 3 of these 33 patients (9.1%) were correctly diagnosed by CT scanning. CONCLUSIONS: Although additional numbers of patients with high PSA levels need to be evaluated, we could not find any justification for routine preoperative CT scanning in patients with a PSA of less than 25 ng/mL. These results suggest that significant savings can be realized by abandoning the practice of routine CT scanning for lymph node metastasis in all patients with newly diagnosed prostate cancer.

Humans↗
PubMed1997

Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis.

OBJECTIVES: To assess prospectively-using pad test and questionnaire-the rate and degree of incontinence after radical retropubic prostatectomy, to analyze factors that may predispose individuals to postoperative incontinence, and to assess the impact of incontinence on patient lifestyle. METHODS: Fifty-one consecutive patients were assessed at 3-month intervals for 1 year after radical retropubic prostatectomy. Patients were objectively assessed using a 1-hour pad test and subjectively assessed by questionnaire. Incontinence was graded objectively according to the change in weight of the pad at 1 hour and subjectively by the number of pads used per day. Lifestyle modifications were assessed by questionnaire at 12 months. A number of variable factors were studied to assess risk factors for postoperative incontinence. RESULTS: Continence continued to improve up to 12 months. At 12 months, pad testing revealed 84% of patients were dry, 6% were mildly incontinent. 6% were moderately incontinent, and 4% were severely incontinent. Questionnaire assessment revealed 80% wore no pad, 14% had mild incontinence, 4% had moderate incontinence, and 2% had severe incontinence. Pad testing was not as sensitive as the questionnaire for the detection of minimal incontinence but was more reliable for moderate and severe levels. Patients made lifestyle changes proportional to the level of incontinence. No predisposing factor was identified for the development of incontinence after radical retropubic prostatectomy. CONCLUSIONS: Significant incontinence after radical prostatectomy occurs in as many as 10% of patients. Pad testing provides an inexpensive and simple form of objective assessment in patients with bothersome incontinence and allows documentation of improvement over time.

Aged↗
PubMed1997

Stage D1 (T1-3, N1-3, M0) prostate cancer: a case-controlled comparison of conservative treatment versus radical prostatectomy.

OBJECTIVES: There is no consensus on the management of Stage D1 prostate cancer. The literature suggests that radical prostatectomy, as compared with pelvic lymphadenectomy (PLND) alone, may extend survival, Despite evidence that lymph node tumor burden influences cancer survival, few groups of researchers have controlled for this variable when comparing management strategies. We performed a study that was case-controlled for nodal tumor burden to determine if a survival advantage exists for radical prostatectomy. METHODS: Of 168 men with Stage D1 disease diagnosed between 1983 and 1995, 127 underwent pelvic lymphadenectomy and radical retropubic prostatectomy (PLND/RRP) and 41 underwent PLND alone. Clinical charts were reviewed for follow-up, and lymph node tumor burden was assessed by volume of nodal metastases and the percentage of positive nodes sampled. Adjuvant treatment was based on the surgeon's preference and clinical situation. Nineteen patients from each group were matched for age, PSA, Gleason score, clinical stage, follow-up, and nodal tumor burden. RESULTS: Comparison of the non-case-controlled PLND/RRP and PLND groups showed no differences in age, prostate-specific antigen level, Gleason score, clinical stage, or follow-up. The nodal tumor burden was greater for the PLND group (P = 0.001). The 10-year cancer-specific survival rates for the PLND/RRP and PLND groups were statistically different (P = 0.006). In the case-controlled group, the results were similar for cancer-specific survival at 10 years (56% and 34%, respectively; P = 0.09). CONCLUSIONS: These data suggest that in Stage D1 prostate cancer, a trend toward a statistical difference in survival may exist for radical prostatectomy as compared with conservative treatment. Further case-controlled and prospective randomized studies are needed to verify these results.

Actuarial Analysis↗