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PubMed1991

Radical prostatectomy for carcinoma of the prostate: long-term follow-up of 115 patients.

From July 1969 to September 1990, 370 patients with prostatic cancer underwent radical prostatectomy at our institution. Of these 370 patients, 115 consecutive patients could be followed for more than 10 years (mean 12.5). Patients with stage pT1-pT3 tumors received no further treatment until progression occurred. Patients with regional lymph node metastases (stages pT2-3pN1-2M0) were treated by either an immediate orchiectomy or an adjuvant hormonal therapy. No radiotherapy was applied prior to radical prostatectomy or thereafter. Of the 115 patients followed for more than 10 years, 84 had stage pT1-2, 22 had stage pT3, and 9 had stage pT2-3pN1-2 tumors. The observed 10-year survival rate of all 115 patients (including those with regional lymph node metastases) was found to be 67.0%. The 10-year disease-free survival rate was 58.3% and the tumor-related survival rate was 83.5%. Considering only patients with locally confined (stage pT1-2) tumors, the 10-year survival rate was 75.0%. This observed survival rate equals the 10-year survival expectancy of a male age-matched control population (69.9%). Progression (local recurrence or distant metastatic spread) was noted in 27.8% of patients within the 10-year interval after radical prostatectomy. Within this time interval, 16.5% of the patients died from their disease.

Adult↗
PubMed1996

Rectal perforation after retropubic radical prostatectomy: occurrence and management.

OBJECTIVES: A surgical audit of the management of rectal perforations during retropubic radical prostatectomy. Assessment of incidence, risk factors, management and outcome. METHODS: All 10 cases (3.6%) sustaining a rectal injury of a total series of 270, while undergoing retropubic radical prostatectomy at our 2 institutions were reviewed. In all cases, the injury was immediately recognized and treated by primary suture, anal dilatation and antibiotics. In 1 case, a temporary colostomy was performed. RESULTS: Recovery was uneventful in all cases, and the postoperative hospitalization was only slightly longer than usual in the 9 cases without fecal diversion. No fistulae or wound infections occurred, but closure of 1 colostomy was complicated. CONCLUSION: Provided that the injury is promptly recognized and properly sutured, a rectal perforation at radical prostatectomy is not of great significance and should not deter from an adequate preoperative investigation by multiple transrectal core biopsies or neoadjuvant hormonal treatment. The use of preoperative bowel preparation, routine antibiotic prophylaxis, omental interposition or a proximal colostomy does not appear to be necessary in order to achieve immediate safe repair.

Aged↗
PubMed1996

The risk of malignancy in the surgical margin at radical prostatectomy reduced almost three-fold in patients given neo-adjuvant hormone treatment.

OBJECTIVES: To investigate the outcome of neo-adjuvant hormone treatment before radical prostatectomy regarding local tumour extension, peri-operative blood loss and operation time. PATIENTS: Of 111 surgically treated patients with prostate cancer (T1b-T3a, N0, M0, G1-3), 55 were randomised to immediate radical prostatectomy and 56 to 3 months of neo-adjuvant treatment with triptorelin (3.75 mg i.m. every 28 days) and cyproterone acetate (50 mg b.i.d. for 3 weeks to prevent flare). RESULTS: No differences were found in blood loss or operation time but patients who had neo-adjuvant treatment had a significantly lower frequency of positive margins (41 vs. 23%, p = 0.013). CONCLUSION: Neo-adjuvant treatment does not facilitate radical prostatectomy but may improve the chance of local cure. This must, however, be documented with long-term follow-up in randomised patients.

Aged↗
PubMed1996

The Oxford Laser Prostate Trial: sexual function data from a randomized controlled clinical trial of contact laser prostatectomy.

OBJECTIVE: To examine the effects of contact laser vaporization prostatectomy and transurethral resection of the prostate (TURP) on sexual function and to examine their association with treatment satisfaction. METHODS: Data on sexual function were collected pre-operatively and 3 months after contact laser vaporization prostatectomy or TURP. The sexual outcome was examined in relation to satisfaction with treatment and quality of life. RESULTS: A wide variation in sexual function was seen at baseline with overall 45% of the patients being impotent during the previous year and 49% claiming to not always have erections when stimulated 1 month prior to surgery. At 3 months postoperatively, 4% of the laser and 3% of the TURP patients who were previously potent were now impotent. There were no statistically significant associations between preoperative or postoperative (3 months) sexual function and either age, preoperative catheterization, or prostate volume. CONCLUSION: The impotence rate 1 month prior to surgery is higher than in previous reports, and the impotence rate after contact laser prostatectomy in this sample size is similar to that seen following TURP.

Aged↗
PubMed1993

Radical prostatectomy or wait-and-watch?

With intensified screening and the use of new diagnostic tools for prostate cancer (prostate-specific antigen, rectal ultrasound, magnetic resonance imaging with rectal coils, etc), the number of newly diagnosed cases of prostate cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long-term survivor after radical prostatectomy owes his survival to the treatment. Long-term survivorship may reflect the relatively benign biological potential of this disease in an individual patient. Therefore, there is an inherent risk of overtreating patients and this must be weighed against the costs, the postoperative morbidity and the, albeit low, mortality of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostate cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-confined disease.

Aged↗
PubMed1993

Transcoccygeal radical prostatectomy for localized prostate cancer: early clinical results.

Twelve patients with adenocarcinoma of the prostate underwent radical transcoccygeal prostatectomy. The methodology and outcome are described. Preoperative laparoscopic lymphadenectomy was performed on all patients. The average operative time for the prostatectomy using the transcoccygeal route was 3 h and 7 min, and no major postoperative complications occurred. Compared to the classic retropubic approach, preservation of the neurovascular bundles and urethral anastomosis seemed to be facilitated. It was concluded that radical prostatectomy can be performed safely using the transcoccygeal approach.

Adenocarcinoma↗
PubMed1997

Impact of minimal lymph node metastasis on long-term prognosis after radical prostatectomy.

OBJECTIVES: In the management of clinically localized prostate cancer, understanding is of major concern. There is a considerable therapeutic dilemma in those patients in whom staging lymphadenectomy prior to intended radical prostatectomy reveals lymph node metastases. METHODS: Pelvic lymph node dissection and radical retropubic prostatectomy were performed in 132 consecutive patients. Patients with extracapsular disease and/or positive lymph nodes received adjuvant radiotherapy. Median follow-up after surgery was 7 years and 2 months. To study the influence of minimal lymph node metastasis, category pN1 was further subdivided into pN1.1 and pN1.2. Involvement of the prostatic capsule was either classified as infiltration (pT3.1) or performation (pT3.2) of the capsule. RESULTS: Disease-free survival after 10 years was 58% in patients with negative nodes, 37% in category pN1.1, 25% in category pN1.2 and 10% in category pN2. Corrected overall survival was 83% for node-negative patients and 73% for category pN1.1, but it was only 33% for pN1.2 and 29% for pN2. Patients in category pT3.1 had a statistically significant better survival than those in pT3.2. CONCLUSIONS: We conclude that radical prostatectomy combined with adjuvant radiotherapy is a valuable option in prostate cancer patients with minimal lymph node metastasis. When compared to infiltration of the capsule, complete capsular perforation does adversely affect prognosis.

Adenocarcinoma↗
PubMed1992

Reappraisal of radical perineal prostatectomy.

Radical prostatectomy is frequently the treatment of choice for localized adenocarcinoma of the prostate. The procedure can be accomplished through either a perineal or a retropubic approach; both have their advantages and disadvantages. Recently, concerns over transmission of blood-borne viruses during transfusions and the advent of laparoscopic pelvic lymphadenectomy have resulted in a rejuvenation of interest in perineal prostatectomy. Herein, we discuss the history of perineal prostatectomy, the technique and its advantages and disadvantages.

Humans↗
PubMed1995

Bladder neck preservation following radical prostatectomy: continence and margins.

Between December 1991 and January 1994, 134 patients underwent radical retropubic prostatectomy with bladder neck preservation. Forty-nine patients had a positive margin. Number and location of positive margins were analyzed. A tumor was identified at the bladder neck in 10 cases (7.5%). In all 10 patients with bladder neck involvement, a tumor was also identified at multiple other sites. These data suggest that preservation of the bladder neck during radical prostatectomy does not appear to compromise the efficacy of the procedure. Using a self-administered patient questionnaire, we evaluated the effect of bladder neck preservation upon continence in 36 patients. At the initial 3-month follow-up, 24 (67%) patients did not wear any pads. Another 7 (19%) wore pads occasionally, while 5 (14%) patients wore pads daily. To date only 1 of the 134 patients has developed an anastomotic stricture. Bladder neck preservation may aid in an earlier return of continence following radical prostatectomy and reduces anastomotic strictures. It does not appear to compromise the removal of the cancer.

Humans↗
PubMedDate not supplied

Is it possible to provide a prognosis after radical prostatectomy for prostate cancer by means of a PSA regression model?

BACKGROUND: For over 15 years, studies have been done to evaluate the elimination kinetics of the prostate-specific antigen (PSA) after radical prostatectomy. Even though evaluation of PSA regression in the two-compartment model has become established, no clear data are currently available as to whether a statement can be made with regard to tumor prognosis from a computation of the PSA half-life (PSA-HL). This study focuses on the determination of the PSA-HL in the two-compartment model and on its correlation with the biochemical recurrence-free survival. In addition, a computer program is being developed to simplify the determination of PSA-HL. MATERIAL AND METHODS: Seventy-seven prospective patients were examined who subsequently had a radical prostatectomy at our facility without neoadjuvant or adjuvant hormone deprivation. In addition to preoperative measurement of the PSA value (dO), PSA determinations were carried out postoperatively on days 5, 10 and 60, and at four-monthly intervals thereafter (mean follow-up: 16 months). By means of the computer program developed for this purpose, CTK.TumW, the PSA half-lives for the first (d0-d5, PSA-HL1) and second (d5-d10, PSA-HL2) compartments were subsequently determined and their effect on biochemical recurrence-free survival was assessed. RESULTS: PSA-HL1 and PSA-HL2 were 1.89 (+/- 0.03) and 3.39 (+/- 0.14) days, respectively. Whilst PSA-HL1 did not permit any prognostic statement, the median PSA-HL in the second compartment between patients with and without disease progression differed significantly (4.44 versus 3.12 days; p < 0.001). Discrimination analysis produced a cutoff of 3.8 days for the second compartment; patients with a PSA-HL2 > or = 3.8 days had a significantly worse biochemical recurrence-free survival after 18 months than the other patients (27% versus 93%; p < 0.001). CONCLUSION: The PSA regression kinetics after radical prostatectomy follows a two-compartment model in which the prognostic value of the PSA-HL1 is limited. When a cutoff of 3.8 days is used, evaluation of the PSA-HL in compartment 2 (d5-10) appears to permit a prognostic statement. Due to the limited postsurgical follow-up, the disease process was only assessed as biochemical recurrence-free survival, and a longer follow-up will be necessary to generate data on progression-free survival.

Aged↗
PubMedDate not supplied

Quality of life after radical prostatectomy.

PURPOSE/OBJECTIVES: To examine physical and psychosocial factors that affect the quality of life (QOL) for men 12-24 months after radical prostatectomy treatment for prostate cancer. DESIGN: Cross-sectional survey. SETTING: An entire population from one tumor registry. SAMPLE: Of the 132 men meeting inclusion criteria, 97 men responded, with 91 meeting analysis requirements. Analysis was completed on the Caucasian sample (n = 88) with a mean age of 66 years. Most men were married, lived with a spouse or partner, and had a high level of education. METHODS: A survey was developed to assess men 12-24 months prostatectomy. The tumor registry mailed the survey, which was completed at home, and participants returned it in a prestamped, addressed envelope. MAIN RESEARCH VARIABLES: Major hypotheses in the causal model were that age, sexual function, urinary function, and sexual appraisal would only have indirect effects on QOL, whereas urinary function appraisal, self-esteem, anger suppression, perceived social support, depression, and health locus of control would directly affect QOL. FINDINGS: As analyzed by path analytic techniques, the hypothesized causal model explained 72% variance in the QOL variable. Perceived social support, self-esteem, and health locus of control were significant predictors of QOL. Urinary function appraisal contributed indirectly through health locus of control. Contrary to the hypotheses, anger suppression and depression were not significant predictors of QOL. CONCLUSIONS: After radical prostatectomy for prostate cancer, perceived social support, self-esteem, and health locus of control may influence men's QOL. Future research is needed to increase understanding about the adaptation trajectory of men's response to the impact of prostate cancer. IMPLICATIONS FOR NURSING: Nurses can help patients by providing a thorough assessment of each patient's values that may affect QOL before any intervention begins, using research-based evidence regarding potential side effects of interventions, clear and concise information from a variety of sources that addresses the possible concerns of men and their spouses, and focused counseling that addresses patient-specific problems.

Adult↗
PubMed1997

Presence of circulating prostate cells in the bone marrow of patients undergoing radical prostatectomy is predictive of disease-free survival.

PURPOSE: To determine whether the presence of circulating prostate cells in the bone marrow is associated with disease-free survival in patients undergoing radical prostatectomy. MATERIALS AND METHODS: We evaluated the bone marrow of 86 patients with clinically localized prostate cancer treated by radical prostatectomy for the presence of circulating prostate cells using reverse-transcriptase polymerase chain reaction (RT-PCR) amplification of prostate-specific antigen (PSA) mRNA. Follow-up duration ranged from 1 to 43 months (mean, 15.4). RESULTS: Two of 47 patients (4%) with negative RT-PCR PSA results and 10 of 39 patients (26%) with positive RT-PCR PSA results have had disease recurrence. Patients whose RT-PCR PSA results were positive had a significantly shorter disease-free survival period than those patients with negative RT-PCR PSA results (P = .004). RT-PCR status correlated significantly with serum PSA level (P = .001) and pathologic stage (P = .003). Based on Cox's proportional hazards models, RT-PCR status was found to be a significant predictor of disease-free survival. However, after controlling for PSA level, RT-PCR status was not significant in predicting disease-free survival. CONCLUSION: RT-PCR PSA of bone marrow may be a useful pretreatment prognostic test for patients undergoing radical prostatectomy. Currently, this test should not be used to determine if patients receive definitive local therapy.

Adenocarcinoma↗
PubMed1998

Radioimmunoscintigraphy with In-111-labeled capromab pendetide predicts prostate cancer response to salvage radiotherapy after failed radical prostatectomy.

PURPOSE: We investigated the ability of In-111-capromab pendetide to separate patients who have failed radical prostatectomy into categories of those who would versus those who would not respond to salvage radiotherapy. METHODS: Prostate-specific antigen (PSA) levels in 32 men with prostate cancer who had failed radical prostatectomy and had undergone a whole-body In-111-capromab pendetide scan were followed-up for 13 months (median) after salvage radiotherapy to the pelvis. A logistic regression model was used to determine whether the scan findings, as well as other clinical variables, were associated with a durable complete response (DCR), a nondurable response (NDR), or no response (NR). RESULTS: Sixteen of 23 (70%) men with a normal scan outside the prostatic fossa achieved a DCR after salvage radiotherapy versus two of nine (22%) who had a positive scan outside the prostate fossa and pelvis (P = .0225, Fisher's exact test). Predicted probability (95% confidence interval [CI]) that a DCR would be obtained with a normal scan was 0.88 (0.55 to 0.98); for men with a positive scan limited to the prostatic fossa it was 0.62 (0.42 to 0.79); and for men with a positive scan outside the pelvis it was 0.27 (0.09 to 0.58). No other variables before radiotherapy showed a significant association with the DCR rate. CONCLUSION: Salvage radiotherapy is statistically more likely to lead to a durable complete PSA response in men with prostate cancer who have failed radical prostatectomy and have a negative In-111-capromab pendetide scan outside the pelvis as compared with those who have a positive scan.

Aged↗
PubMed2001

Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy.

PURPOSE: To identify factors predictive of local recurrence as defined by a complete response to salvage radiation therapy in patients whose disease recurs after radical prostatectomy. PATIENTS AND METHODS: Ninety-five patients with recurrence after radical prostatectomy who were evaluated by prostatic fossa biopsies, and a subset of 49 of these patients treated with radiation for control of presumed or biopsy-proven local recurrence, were studied. RESULTS: Biopsies were positive in 40 (42%) of the 95 biopsied patients. Multivariate analysis revealed that prebiopsy prostate-specific antigen (PSA) level, postrecurrence PSA doubling time, and positive digital rectal examination (DRE) of the prostatic fossa were all statistically significant predictors of a positive biopsy. For the 49 patients subsequently treated with salvage radiation therapy, the overall actuarial 3- and 5-year PSA relapse-free probabilities were 43% and 24%, respectively. Univariate analysis showed no differences in the PSA relapse-free probabilities associated with any pathologic features of the radical prostatectomy specimen, biopsy confirmation of local recurrence, or DRE of the prostatic fossa. In multivariate analysis, controlling for all other variables, preradiation PSA and postrecurrence PSA doubling time measured before radiation were the only statistically significant predictors of outcome. CONCLUSION: DRE of the prostatic fossa, prebiopsy PSA, and postrecurrence PSA doubling time predict which patients will have biopsy-proven local recurrence. However, response to salvage radiation therapy is associated with postrecurrence PSA doubling time and with preradiation PSA level only. DRE of the prostatic fossa and biopsy confirmation of local recurrence are not associated with salvage radiation outcome.

Aged↗
PubMed2003

Role of surgeon volume in radical prostatectomy outcomes.

PURPOSE: To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor. PATIENTS AND METHODS: Using 1997 to 1998 claims data from a national 5% random sample of Medicare beneficiaries, we identified 2,292 men who underwent radical prostatectomy at 1,210 hospitals by 1,788 surgeons. Hospitals were classified as high (> or = 60 per year) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high (> or = 40 per year) or low (< 40 per year) volume. Multivariate logistic regression was performed to control for patient demographics and comorbidities when assessing the association of hospital and surgeon volume with in-hospital complications, length of stay, and anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and miscellaneous surgical and medical conditions. RESULTS: High-volume surgeons had half the complication risk (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.32 to 0.89) and shorter lengths of stay (4.1 v 5.2 days, P =.03) compared with low-volume surgeons. High-volume hospital patients tended to have fewer anastomotic strictures (OR = 0.72; 95% CI, 0.49 to 1.04). Patient age (> or = 75 years) was associated with more complications (OR = 1.9; 95% CI, 1.39 to 2.70), more anastomotic strictures (OR = 2.2; 95% CI, 1.54 to 3.15), and longer hospital stays (parameter estimate = 2.26; 95% CI, 1.75 to 2.77). CONCLUSION: Surgeon volume is inversely related to in-hospital complications and length of stay in men undergoing radical prostatectomy. Hospital volume is not significantly associated with outcomes after adjusting for physician volume. Further study is necessary to elucidate the mechanism of the volume-outcome effect.

Aged↗
PubMed2003

Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer.

PURPOSE: To identify predictors of biochemical outcome following radiotherapy in patients with a rising prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer. PATIENTS AND METHODS: One hundred fifteen patients with a rising PSA after radical prostatectomy received salvage three-dimensional conformal radiotherapy (3D-CRT) alone or with neoadjuvant androgen deprivation. Tumor-related and treatment-related factors were evaluated to identify predictors of subsequent PSA failure. RESULTS: The median follow-up time after 3D-CRT was 42 months. The 4-year actuarial PSA relapse-free survival, distant metastasis-free survival, and overall survival rates were 46%, 83%, and 95%, respectively. Multivariate analysis, which was limited to 70 patients receiving radiation without androgen deprivation therapy, showed that negative/close margins (P =.03), absence of extracapsular extension (P <.01), and presence of seminal vesicle invasion (P <.01) were independent predictors of PSA relapse after radiotherapy. Neoadjuvant androgen deprivation did not improve the 4-year PSA relapse-free survival in patients with positive margins, extracapsular extension, and no seminal vesicle invasion (P =.24). However, neoadjuvant androgen deprivation did improve PSA relapse-free survival when one or more of these variables were absent (P =.03). CONCLUSIONS: Salvage 3D-CRT can provide biochemical control in selected patients with a rising PSA after radical prostatectomy. Among patients with positive margins and no poor prognostic features, 77% achieved PSA control after salvage 3D-CRT. Salvage neoadjuvant androgen deprivation therapy may improve short-term biochemical control, but it requires further study.

Adult↗
PubMed1997

Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy.

The aim of this study was to evaluate CT imaging in the post-operative follow-up and in the detection of recurrence after radical prostatectomy in cases of prostatic carcinoma. In over 500 patients undergoing radical prostatectomy for prostatic carcinoma, 22 cases with local recurrence were found. CT examinations of the pelvis were retrospectively evaluated in these patients. Local recurrence was detected by PSA uptake and confirmed by transrectal ultrasound (TRUS) in combination with guided biopsy. In 22 cases of confirmed local recurrence, positive results on CT were found in eight patients (36%) and negative results in nine patients (41%). In the remaining five cases (23%), no distinction could be made between scar and local recurrence. All cases definitively classified as recurrent tumour disease showed a soft tissue mass of 2 cm or more. CT sensitivity in local recurrence of prostatic carcinoma after surgery is low. Even in a very careful follow-up, the understaging would be up to 41%. In comparison, PSA, TRUS and needle biopsy are the methods of choice and are superior to CT imaging. Based on these results, there would be no reason for including pelvic CT examinations in the follow-up of prostatic carcinoma after radical prostatectomy.

Follow-Up Studies↗
PubMed2001

The relative importance of anatomic and PSA factors to outcomes after radical prostatectomy for prostate cancer.

We report on how anatomic pathology observations and prostate-specific antigen (PSA) observations made before and just after radical prostatectomy relate to subsequent outcomes in men with prostate cancer. Our study patients consisted of more than 200 men who underwent radical prostatectomy and who had a mean follow-up of more than 6 years. We found that there were 2 categories of failures after surgery--one consisting of an eventual elevated PSA level and the other consisting of an early death from progressive tumor--and that these 2 failures related differently to PSA and anatomic pathology observations made at the time of prostatectomy. Whereas preoperative and postoperative levels of PSA related most closely to PSA failure, Gleason grade 5 and the percentage carcinoma related most closely to early death. Our results suggest how men could be sorted into 3 prognostic categories after surgery: one with high hazard for early death, a second with low hazard for early death but with high probability for eventual elevated PSA level, and a third with overall good prognosis.

Adenocarcinoma↗