Patient selection for radical prostatectomy.
Reduced patient morbidity and broadened surgical experience have increased the use of radical prostatectomy for carcinoma of the prostate. Urologists generally agree that patients with palpable lesions confined within the prostate are suitable candidates for the procedure. Ninety-one percent of patients with clinical Stage B1 tumors treated at the University of Utah are alive and free of disease at five years, but this figure decreases to 52 percent at ten years. For Stage B2 tumors, five- and ten-year disease-free survival figures are 81 and 50 percent, respectively. Increasing enthusiasm for radical prostatectomy in patients with Stage A1 tumors is based on a projected 8-18 percent possibility of disease progression. On the other hand, the likelihood that Stage A1 patients will not progress, the inability to predict accurately the small group of patients in whom problems will develop, and the probability that radical prostatectomy does not cure all patients who are at risk for progression argue against radical surgery for most Stage A1 patients. There is little rationale for surgery alone in patients with known extracapsular tumor extension when surgical margins are likely to be positive. Whether adjuvant radiation treatment or hormonal therapy will improve results is uncertain, but appropriate clinical trials to answer these questions have been initiated.