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PubMed1995

A comparison of transurethral prostatectomy with visual laser ablation of the prostate using the Urolase right-angle fiber for the treatment of BPH.

The use of right-angle laser fibers for the treatment of benign prostatic hyperplasia (BPH) has gained widespread acceptance over the past several years. The number of right-angle fibers introduced into the marketplace has continued to grow, but most fibers have not been evaluated thoroughly with properly designed clinical trials. The Urolase fiber has undergone the most extensive clinical trials conducted to date. This report reviews the significant clinical trials with particular emphasis on the comparison of transurethral prostatectomy with visual laser ablation of the prostate. From these initial results, it would appear that laser ablation using the Urolase fiber is a safe and effective surgical therapy for men with symptomatic BPH. From our analysis, it would appear that transurethral prostatectomy provides a greater degree of symptomatic improvement as compared with transurethral resection of the prostate. It is important to consider that these are some of the earliest clinical trials assessing the efficacy of laser prostatectomy and that technological advancements are likely to improve the clinical outcome.

Humans↗
PubMed1994

Does radical prostatectomy in the presence of positive pelvic lymph nodes enhance survival?

A retrospective review was performed on all patients with stage D1 prostate cancer treated at Duke University Medical Center between 1975 and 1989. A total of 156 patients underwent staging pelvic lymph-node dissection for clinically organ-confined prostate cancer (stage A or B) but were found to have disease metastatic to the pelvic lymph nodes (stage D1). Of this population, 42 patients also underwent radical prostatectomy (group 1), leaving 114 who did not have their prostate removed (group 2). The median cancer-specific survival was 11.2 years for group 1 versus 5.8 years for group 2 (P = 0.005). In patients with one or two positive lymph nodes the median cancer-specific survival was 10.2 years for group 1 versus 5.9 years for group 2 (P = 0.015). There was no difference in survival if three or more lymph nodes were positive. Adjuvant treatment with immediate androgen deprivation and/or postoperative radiation therapy failed to improve the survival experience. The incidence of local problems, including stricture formation, bleeding, or regrowth of cancer requiring dilation or surgical intervention (transurethral prostatectomy) averaged 9.5% in group 1 and 24.6% in group 2. These data show that patients with limited node-positive disease selected for radical prostatectomy experience a survival advantage over those denied such therapy and that this advantage is independent of adjunctive therapy.

Aged↗
PubMed1989

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment.

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.

Aged↗
PubMed1997

Detection of circulating prostatic cells during radical prostatectomy.

The detection of micrometastasis of prostate cancer could help to decide more appropriate therapeutic strategies in an individual patient. We have developed a flow cytometric method for detecting cytokeratin-positive cells in the peripheral blood before, during and after radical prostatectomy in patients with prostatic carcinoma. By means of this technique we were able to detect a higher number of cytokeratin-positive cells in the intraoperative blood sample than in the pre- and postoperative blood sample in 15 patients with prostate cancer (P < 0.05). Our results show an increase in the number of cytokeratin-positive cells with increasing tumor stage and grade, as well a good correlation of prostate-specific antigen (PSA) value with the number of cytokeratin-positive cells (r > 0.6). Our results underline the importance of no-touch techniques at prostatectomy to minimize release of tumor cells into the circulation during surgery. In the light of our results we consider that the indication for cell savers during radical prostatectomy should be reevaluated. The possibility of detecting single metastatic cells in peripheral blood will enable better individual patient management, and open up new modalities for diagnosing early prostate cancer and enhancing patient monitoring in relapse and tumor progression.

Aged↗
PubMed1983

Appraisal of retropublic sagittal prostatectomy.

An operative technique, called retropubic sagittal prostatectomy, is described. The technique is based on the surgical anatomy of the prostatic capsule, previously studied and reported by the author. Forty-two patients treated by the method are presented and compared with another group of 37 own patients who had earlier had Millin's retropubic prostatectomy. Retropubic sagittal prostatectomy proved technically simpler than Millin's retropubic operation, but with equally excellent results and probably slighter blood loss.

Evaluation Studies as Topic↗
PubMed2002

The value of PSA measurements at 30 Gy, 50 Gy and 60 Gy for dose limitation in patients with radiotherapy for PSA increase after radical prostatectomy.

BACKGROUND: Radiation therapy is a treatment option for patients with rising PSA after radical prostatectomy without histological evidence of local relapse and no signs of distant metastases. Prior to radiotherapy there is no certainty whether a patient is going to respond to the treatment or not. When total doses of more than 60 Gy are given there is an exponential rise in treatment-related late toxicity. Therefore those patients in whom radiotherapy later appears to be ineffective may benefit from a dose restriction to 50-60 Gy. The aim of this study was to examine the prognostic value of PSA levels evaluated during radiotherapy. PATIENTS AND METHODS: 41 patients with rising PSA level following prostatectomy received radiotherapy to the prostatic bed and were treated up to a median dose of 66.6 Gy. We evaluated serum PSA levels during radiotherapy at 30 Gy, 50 Gy, and 60 Gy and compared them to the pre-radiotherapy PSA level and the outcome of radiotherapy. RESULTS: After radiotherapy, 31 patients (76%) had either undetectable (n = 15), or decreasing but still detectable PSA levels (n = 16) and ten patients (24%) had rising PSA levels and did not respond. PSA evaluation at 30 Gy showed that 26% (8/31) of those patients who would respond to radiotherapy still had a rising PSA when compared to pretreatment PSA. At 50 Gy and 60 Gy 93% (27/29) of these patients had decreasing PSA levels. In contrast, 75% (6/8) and 88% (7/8) of those patients in whom radiotherapy was not effective had rising PSA levels at 50 Gy and 60 Gy (p < 0.05). CONCLUSIONS: PSA measurements at 30 Gy, 50 Gy and 60 Gy for radiotherapy of PSA increase following radical prostatectomy without histologically proven local recurrence gives valuable information about the later tumor response. Therefore it possibly gives the opportunity to finish radiotherapy between 50 and 60 Gy, as almost all patients with continued PSA increase at 60 Gy do not stand to profit from radiotherapy. In these patients dose limitation would significantly decrease the risk of late side effects, especially for the bladder and the rectum. PSA evaluations at 30 Gy and 50 Gy or 60 Gy are recommendable.

Aged↗
PubMed2005

Results of three dimensional conformal radiotherapy and hormonal therapy for local recurrence after radical prostatectomy.

BACKGROUND AND PURPOSE: Analysis of treatment results of combined three-dimensional conformal radiotherapy (3DCRT) and hormonal therapy in patients with locally recurrent prostate cancer after radical prostatectomy. PATIENTS AND METHODS: Between 1992 and 1998, 24 patients presented with a rising prostate-specific antigen (PSA) between 4 and 152 months following radical prostatectomy and a local recurrence demonstrated by imaging. Recurrence was biopsy-proven in 13 cases. All patients were treated with 3DCRT to a total dose of 60-70 Gy. 21 patients (88%) received adjuvant hormone therapy up to a maximum of 6 months. RESULTS: All patients showed a response in PSA values after therapy. Median follow-up is 43 months. Overall survival is 80% and 67% at 3 and 5 years, respectively. Biochemical control rates are 53% and 38% at 3 and 5 years, respectively. 14 patients developed a second PSA relapse. Acute and late toxicities, classified with the RTOG score, were moderate. CONCLUSION: Radiotherapy and short-term adjuvant hormone therapy represent an effective and well-tolerated treatment for locally recurrent prostate cancer after radical prostatectomy resulting in good local control. Long-term prognosis in terms of biochemical control and disease-specific survival remains poor.

Adenocarcinoma↗
PubMed1997

[Advantages and limitations of intraoperative mechanical autotransfusion in al prostatectomies].

UNLABELLED: Intraoperative autotransfusion (MAT), preoperative autologous blood donation, and preoperative normovolaemic haemodilution are three different methods to avoid homologous blood transfusion during surgical procedures. The controversial use of MAT via cell saver in tumour surgery as well as contamination of the operative field with urine illustrate the particular difficulties of autologous blood transfusion in connection with radical prostatectomy. We investigated changes in the osmotic resistance of the retransfused red blood cells (RBC), bacterial contamination, changes in coagulation parameters, and the presence of tumour cells. PATIENTS AND METHODS: After written informed consent, 24 patients who presented for radical prostatectomy were randomly allocated to either a group that used MAT or a group that used homologous transfusion. The patients received "balanced anaesthesia" with midazolam, fentanyl, atracurium, and nitrous oxide/oxygen. The analysed parameters from the preoperative period to the 3rd postoperative day are shown in Table 1. The Haemonetics 3 Plus Cell Saver was used for autotransfusion. RESULTS: Our results showed that the haematologic parameters, coagulation factors, and serum chemistry did not differ between the two groups (Tables 2-4). However, there were significant differences during the investigated period. The osmotic resistance of the salvaged RBCs was higher than that preoperatively. Furthermore, there were no tumour cells in the autologous salvaged RBCs. CONCLUSION: Our results showed no decrease in the quality of the autotransfused RBCs, urine was not retransfused; and there were no significant differences between the groups postoperatively. Although there were no tumour cells in the salvaged blood, the possibility of blood irradiation is discussed. We concluded that because of the risk of infection of homologous blood products, MAT is a safe possibility to reduce the amount of homologous blood transfusion required in connection with radical prostatectomy.

Aged↗
PubMed2002

[Robot-assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions].

Complex reconstructive laparoscopic procedures in the field of urology such as radical prostatectomy and pyeloplasty have attracted increased attention in the past 2 years. However, extensive laparoscopic experience is required to master these procedures. Therefore, it remains questionable whether these techniques, which have been shown to be of profit to the patient in the hands of a specialist, will achieve widespread distribution. We have employed computer technology to bridge the gap between open surgery and laparoscopic access and used the daVinci Surgical System to establish laparoscopic radical prostatectomy as well as pyeloplasty and other retroperitoneal procedures at our institution. With experience of more than 70 procedures, we find that with the assistance of the daVinci Surgical System both radical prostatectomy and retroperiteoneal procedures can be easily translated from open to minimally invasive procedures with a considerably shorter learning curve and without compromising patient safety. We expect that large incisions will be soon a thing of the past in urologic surgery. Computer technology, together with mechanical engineering, will play a major role in enabling us to achieve better results despite minimal invasiveness.

Female↗
PubMed2003

[Functional results of various surgical techniques for radical prostatectomy].

Radical prostatectomy for the treatment of prostate cancer can be performed by various techniques using a retropubic, perineal, or laparoscopic approach. Besides tumor control, the postoperative urinary continence rates and potency rates impact patients' quality of life after radical prostatectomy. This paper shows the results of our own center and compares the data in the literature regarding functional results of radical prostatectomy with respect to various operative techniques.

Aged↗
PubMed2004

[The significance of comorbidity and age in radical prostatectomy].

The coexistence of another diagnosis beside the index disease under study is defined as comorbidity. Comorbidity increases with advancing age. In candidates for radical prostatectomy, two aspects of comorbidity are of interest: its association with perioperative complications and long-term survival. The Charlson score is the most extensively studied comorbidity classification for the prediction of long-term outcome. Several studies have identified this score as an independent prognostic factor in the prostate cancer setting. In addition to the Charlson score, data collected during the preoperative cardiopulmonary risk assessment may deliver information identifying patients with an increased long-term mortality risk. The meaningfulness of comorbidity in predicting overall mortality seems to be comparable to that of the Gleason score, the most important tumor-related predictor of survival in prostate cancer. The identification of prognostically relevant single conditions and the development of a "radical prostatectomy-specific" comorbidity classification might improve the stratification of candidates for radical prostatectomy in the future.

Adolescent↗
PubMed2006

[Functional and oncological outcome of salvage prostatectomy of locally recurrent prostate cancer following radiation therapy].

BACKGROUND: Although technically challenging, salvage radical prostatectomy (SRP) for radiorecurrent prostate cancer (PCA) is an effective option in carefully selected patients and offers the chance for cure and long-term survival. Sometimes local progression of PCA with subvesical obstruction following radiation therapy requires radical cystoprostatectomy or bladder-preserving urinary diversion. We present our experience with salvage radical prostatectomy in a group of 28 consecutive patients. PATIENTS AND METHODS: Between January 2003 and August 2005, 25 patients underwent radical salvage surgery for locally recurrent PCA following external beam radiation (n=14), high-dose brachytherapy (n=8), and low-dose brachytherapy (n=6). All men had biopsy-proved recurrent or persistent PCA associated with PSA progression following radiation therapy. Preoperative imaging studies included bone scintigraphy and computed tomography without evidence of metastatic disease. Of the 28 men, 11 (39%) presented with bothersome irritative voiding dysfunction and rectal discomfort. Life expectancy was >10 years in all cases. We analyzed preoperative symptoms, treatment-associated morbidity, pathohistological findings, and functional and oncological outcome after a mean follow-up of 12.5 (2-29) months. RESULTS: SRP was performed in all cases without significant intra- and perioperative complications: no rectal lacerations or ureteral lesions were encountered and mean blood loss was 520 (200-950) ml. A total of 21 (75%) men underwent SRP: in 4 cases radical cystoprostatectomy was necessary due to bladder neck infiltration and in 3 men SRP with bladder neck closure and continent appendicovesicostomy was performed due to preexisting urinary stress incontinence. All men with subvesical obstruction experienced significant relief of urgency and significant irritative voiding dysfunction following radical salvage surgery. Pathohistological analysis of the prostatectomy specimen revealed pT1-2b PCA in 19 (67.8%), pT3a/b PCA in 5 (17.8%), and lymph node metastasis or positive surgical margins in 7% of the patients. Two patients demonstrated a pT0 despite positive preoperative biopsies, and 20% demonstrated a Gleason score 8-10. With regard to functional outcome, 25% of the men need 2-3 pads daily whereas 78% of the men are continent. After a mean follow-up of 12.5 (2-29) months, two patients with pT3b and pN1 status exhibit a PSA relapse. CONCLUSION: Salvage RP or RCx is a technically challenging but feasible surgical approach with curative intent for the treatment of locally recurrent PCA in well selected patients preventing significant local complications such as subvesical obstruction, ureteral obstruction, hematuria, and rectal infiltration. Surgery-associated morbidity and complications are low and not comparable to earlier series. The indication for salvage RP requires positive biopsy and negative imaging studies.

Aged↗
PubMed2000

[PSA rise after radical prostatectomy].

Approximately 18 % of patients will experience PSA failure only after radical prostatectomy. The rate of clinical (local or systemic) recurrence is in the same range. Clinical recurrence is accompanied by an increasing PSA in almost all cases. Altogether, the 10-year risk of PSA recurrence after radical prostatectomy for clinically localized prostate cancer is about 35 %. PSA relapse precedes the development of metastases by a median time of 8 years. The median survival after the manifestation of metastases is about 4-5 years. To differentiate the reasons of PSA failure, recurrence-free interval, Gleason score and PSA doubling time deliver important information. Patients with a high probability of isolated local failure (PSA relapse later than two years after radical prostatectomy) should undergo a biopsy, if a local radiotherapy is considered. The results of current clinical trials are eagerly awaited to answer the question weather immediate, delayed or intermittent hormonal therapy offer best results in individual cases.

Biomarkers, Tumor↗
PubMed1997

[Urodynamic changes after radical prostatectomy].

Urodynamic examinations were performed in 82 patients with clinically localized prostate cancer before and after radical prostatectomy. A significant decrease in bladder capacity (396 ml to 331.9 ml), urethral closure pressure (89.6 cm H2O to 65.2 cm H2O) and functional profile length (61 mm to 25.9 mm) was noted. The continence rate after radical prostatectomy was 33.4% after 1 month, 69.4% after 3 months, 84.7% after 6 months, and 90.9% after 12 months, respectively. A correlation was found between urethral closure pressure and functional profile length and continence. A second urodynamic examination was performed 6 months after radical prostatectomy. Functional profile length and urethral closure pressure increased. These data suggest that restoration of continence is based on sphincteric parameters.

Adult↗
PubMed1999

[Radical perineal prostatectomy without lymphadenectomy. Patients with cT1 + 2, G1 +2, PSA < or = 10 ng/ml prostate carcinoma].

Pelvic lymphadenectomy in patients with organ confined prostate cancer (PCa) is of no therapeutic value and is questionable in many patients because of the low incidence of metastases. 49 patients with < or = cT2 b, G1 + 2, PSA < or = 10 ng/ml underwent laparocopic pelvine lymphadenectomy and radical perineal prostatectomy. Only 1 patient (2%) had microscopic metastases which were missed on frozen section. Because of these own results and those reported in the literature we then performed in patients with this constellation the radical perineal prostatectomy without lymphadenectomy (n = 32). The differences present in both groups concerning complication rate and morbidity are due to laparoscopic lymphadenectomy and the learning curve in perineal prostatectomy.

Aged↗
PubMed2002

Minimal blood loss in patients undergoing radical retropubic prostatectomy.

The objective of this study was to evaluate blood loss in patients undergoing radical retropubic prostatectomy. Blood loss and operating time were evaluated in a series of 197 consecutive patients with prostate cancer who underwent radical retropubic prostatectomy by a two-surgeon team. The patients were positioned supine with the table flexed and the patient in about 35 degrees Trendelenburg position. Results were compared with those recorded for an earlier series of 40 patients operated in the supine position alone. The influence of parameters that might affect blood loss (peridural and hypotensive anesthesia, bilateral hypogastric artery clamping) was assessed in multivariate analyses. Since adoption of a Trendelenburg position with flexion of the hips, the mean intraoperative blood loss has decreased by 80%, to a low level of 260 cc; and transfusions have become exceptional (0.5%). The decrease in blood loss correlated with a decrease in operating time, which was reduced to an average of 90 minutes. Whereas epidural anesthesia decreased blood loss by a modest 27%, intraoperative blood pressure, bilateral hypogastric artery clamping, and nerve sparing had little or no significant effect. Patient position and the surgical skill of a two-man team can virtually eliminate the risk of blood loss during radical retropubic prostatectomy. There is thus no need always to resort to other procedures or to preoperative autologous blood donation.

Aged↗
PubMed2003

The prognostic value of p53 and DNA ploidy following radical prostatectomy.

This study assesses the correlation of p53 immunoreactivity and DNA ploidy status with biochemical recurrence after radical prostatectomy. p53 protein expression and DNA ploidy were evaluated on 84 archival paraffin-embedded radical prostatectomy specimens. Patients were divided into two groups: those with low (38/84, 45%) and those with high (46/84, 55%) p53 immunoreactivity. The results were correlated with Gleason score, stage and serum PSA. Kaplan-Meier biochemical recurrence free survival and the Cox hazard-regression model were used for analysis. Multivariate analysis revealed p53, DNA ploidy, Gleason score, PSA and stage to be independent prognostic factors in this order. Kaplan-Meier analysis showed a significant difference in biochemical recurrence when p53 high expression and DNA aneuploidy were combined. The results of this study suggest that stratification for p53 expression and DNA ploidy status can provide additional prognostic information for patients with prostate carcinoma after radical prostatectomy.

Aged↗
PubMed2006

Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer.

Radical prostatectomy remains the mainstay for the treatment of localized prostate cancer. Long-term follow-up data showed excellent cancer control rates in several prostatectomy series. We report biochemical recurrence (BCR) outcomes after radical retropubic prostatectomy (RRP) in a European single center series of patients treated over a 13-year period. Between 1992 and 06/2005, 4,277 consecutive men underwent a RRP at the University Hospital Hamburg Eppendorf, Germany. Kaplan-Meier probabilities of BCR-free survival were determined for those patients with complete preoperative data, postoperative data, and follow-up information. Uni-and multivariate Cox regression models addressed PSA recurrence, defined as a PSA level > or = 0.1 ng/ml. Overall, BCR-free survival ranged between 84, 70 and 61% for 2, 5, and 8 years, respectively. In univariate and multivariate analyses, except for age and type of nerve-sparing technique, all traditional clinical and pathological variables represented statistically independent predictors of PSA recurrence-free survival (all P < or = 0.001). In organ-confined disease, the 10-year recurrence free survival rate was 80 and 30% in non-organ-confined cancers. Our findings confirm excellent long-term biochemical cancer-control outcomes after RRP. High grade prostate cancer at final pathology and seminal vesicle invasion proved to be the strongest risk factors of BCR after surgery.

Adult↗