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PubMed2006

[Prostate cancer development after transurethral resection of the prostate--histopathological studies of radical prostatectomy specimens].

PURPOSE: We investigated prostate cancer (ca.) development after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: From 1995 to 2003, 430 patients (pts.) received TURP at Toshiba Rinkan Hospital. Of them, 23 pts. (5.3%) had incidental carcinoma (Stage A), which developed into clinically significant ca. after 1 to 5 years in 5 (22% of Stage A, 1.2% of TURP). In 13 (3.2%) of 407 Non-Stage A pts. (who had no ca. initially), prostate ca. developed after 1 to 7 yrs. A total of 21 pts. (including 3 Stage A pts. diagnosed before 1994) underwent radical prostatectomy. Stage A pts. received regular needle biopsy of prostate (Pbx). Non-Stage A pts. were followed by yearly PSA measurement and digital rectal examination (DRE). Detailed histopathological studies were done on 21 radical prostatectomy specimens. RESULTS: Clinically significant ca. developed in 8 Stage A pts. (all A2) after 1 to 14 yrs. Long term (5 or 10 years) MAB therapy changed moderately-differentiated adenocarcinoma (AC) to poorly-differentiated AC in 2 pts. during follow-up. When ca. developed PSA increased in only 3 of them, DRE was positive just in 1 pt. Tumor invasion was observed mainly in transition zone (TZ), especially anterior to urethra. In spite of no capsular penetration, surgical margin was positive in 2 pts. PSA failure occurred in another 2 pts. Thirteen Non-Stage A pts. showed aggressive ca. (6 moderately-differentiated AC, 6 poorly-differentiated AC, and 1 ductal carcinoma which showed metastasis later), most of which invaded widely in peripheral zone (PZ). Pbx before TURP was done to reveal that there was no cancer in 11 pts. Capsular penetration was seen in 4 pts. Surgical margin was positive in 4 pts. PSA (8.6 +/- 4.0 ng/ml) decreased after TURP but was kept in high level (4.8 +/- 2.2 ng/ml) after 1 year and increased (8.7 +/- 4.5) when cancer was diagnosed in all 13 pts. DRE was positive in 38% of them. Interval between TURP and diagnosis was short in pts. who had cancer of high Gleason Score (GS) or large prostate. CONCLUSIONS: As significant cancer developed in 22% of Stage A pts. (1.2% of TURP) in long term follow-up, regular Pbx (to get TZ tissue) is mandatory regardless of PSA value or DRE. Aggressive cancer developed in 3.2% of Non-Stage A pts. (3.0% of TURP). Pts. with high PSA or abnormal DRE after TURP must receive needle biopsy actively. Considering that more than 4% of TURP pts. eventually require radical prostatectomy, relatively younger pts. who received TURP have to be carefully followed for a long period.

Aged↗
PubMed1997

Transrectal ultrasonographically assisted radical retropubic prostatectomy.

Radical prostatectomy is associated with difficulty in determining the division site of the urethra adjacent to the apical region of the prostate. We present the results of a feasibility clinical trial in three patients to determine whether intraoperative transrectal ultrasonography may assist during radical retropubic prostatectomy. Using this technique the apex is readily identified and a detailed view of the urethral stump could be obtained. In one case residual apical tissue was identified and excised. The creation of the vesicourethral anastomosis was documented and its water tightness was demonstrated. We conclude that transrectal ultrasonography can be performed during radical retropubic prostatectomy and may be helpful in selected cases.

Adenocarcinoma↗
PubMed1999

Prostate specific antigen doubling time after radical prostatectomy: effect of neoadjuvant androgen deprivation therapy.

PURPOSE: We determined the predictors of prostate specific antigen (PSA) doubling time in patients with relapse after radical prostatectomy as well as whether PSA doubling time is shorter in those treated versus not treated with neoadjuvant androgen deprivation therapy. MATERIALS AND METHODS: We calculated PSA doubling time in 204 patients with PSA relapse after radical prostatectomy who were or were not treated with neoadjuvant androgen deprivation therapy. Analysis of covariance was used to determine the effect of clinical and pathological parameters on PSA doubling time, and the proportion of variability explained by these parameters. RESULTS: Clinical stage, and combined clinical stage and margin status, clinical stage and androgen deprivation therapy status, androgen deprivation therapy status and time to PSA relapse, and androgen deprivation therapy status and pretreatment PSA were significant predictors of PSA doubling time. Any variable or combination of variables explained up to only 21% of PSA doubling time variability. When stratified by pretreatment PSA, clinical stage and biopsy grade, the difference in doubling times in patients treated with or without neoadjuvant androgen deprivation therapy was significant only for 4.1 to 10 ng./ml. PSA. In this group mean doubling time plus or minus standard deviation in patients receiving neoadjuvant androgen deprivation therapy and those treated only with radical prostatectomy was 7.6+/-1.0 and 15.4+/-2.6 months, respectively. CONCLUSIONS: Our study indicates that it is difficult to predict PSA doubling time in an individual. The small proportion of variability in PSA doubling time explained by the interaction of androgen deprivation therapy status and other variables indicates that these factors are not clinically significant.

Androgen Antagonists↗
PubMed1998

[Potential of ultrasonography and ultrasonography-guided biopsy in the diagnosis of local recurrence following radical prostatectomy].

INTRODUCTION: [corrected] We investigated the diagnostic role of combined transrectal US (TRUS) and biopsy to detect recurrent cancer after radical prostatectomy, in patients with negative bone scintigraphy and elevated prostate specific antigen (PSA) levels. MATERIALS AND METHODS: From March, 1997, to May, 1998, we examined 12 patients with persistently detectable serum PSA levels and negative bone scintigraphy. At the time of diagnosis, an average 36 months had elapsed since prostatectomy. Digital rectal examination (DRE) and disease stage at the time of surgery were also considered. Patients age ranged 47 to 83 years (mean: 65). All patients underwent TRUS with a 7.5 MHz biplane probe; biopsy was performed with a 16 G cutting needle. TRUS findings were considered suspicious if the scan showed any unusual hypoechoic tissue adjacent to the bladder neck, in retrotrigone or peri-retroanastomotic site. In these cases a transperineal US-guided biopsy was performed. RESULTS: The biopsy proved cancer in 10/12 cases (in 12 cases after two biopsies), showing a better diagnostic accuracy than DRE, which poorly distinguished postoperative changes from recurrent or residual cancer. CONCLUSIONS: The early detection of recurrences after radical prostatectomy in patients with negative bone scintigraphy is feasible when the above examinations are performed in the same order as described: PSA levels, if altered, indicate the patients to be submitted to TRUS. The latter may be falsely negative in some cases because small recurrences may exhibit no findings at US, and therefore US-guided biopsy of peri-retro-anastomotic regions should be always performed too. The recurrence must be confirmed at histology because histologic findings help choose adjuvant treatment and/or radical irradiation.

Aged↗
PubMed1999

Ultrasensitive detection of prostate specific antigen in the followup of 422 patients after radical prostatectomy.

PURPOSE: We validated our ultrasensitive prostate specific antigen (PSA) assay based on lyophilization and 4-fold concentration of patient sera with the clinical long-term followup and according to histopathological characteristics of 422 patients treated with radical retropubic prostatectomy for prostate cancer. MATERIALS AND METHODS: Each serum sample was divided into 2 aliquots for standard and 4-fold concentrated (ultrasensitive) detection. Samples were analyzed by the same unmodified DPC-Immulite PSA assay. Biochemical relapse was defined as an increase of at least 0.10 ng./ml. in native serum (equivalent to 0.025 ng./ml. in concentrated serum). Mean followup was 449 days (range 29 to 2,057). Kaplan-Meier analysis of standard and ultrasensitive detection results was done, and findings were correlated with pathological stage, Gleason grade, total cancer volume, Gleason grade 4 cancer volume and margin status. Significance of earlier detection in ultrasensitive versus standard detection was calculated with the log rank (Mantel-Cox) test with p <0.05 considered significant. RESULTS: Of 442 patients 88 (20.8%) experienced biochemical recurrence. Of this cohort 28 (31%) demonstrated early failure on the ultrasensitive assay which was later confirmed on the standard assay, 37 (42%) had failure simultaneously on both assays and 23 (26%) had failure on the ultrasensitive but remained disease-free on the standard assay. Average time for ultrasensitive assay detection of recurrence was 288 days (standard 555). Kaplan-Meier analysis revealed significant advantages in earlier detection of recurrence with the ultrasensitive assay, and close correlation with pathological stage, Gleason grade, margin status and Gleason grade 4 cancer volume. Time advantages of ultrasensitive versus standard detection were greater for advanced cancers (pT3a/b or greater, Gleason 3 + 4 or greater) than for small, low grade tumors. All patients who had positive results on the standard assay had a previous (28) or simultaneous (37) positive ultrasensitive result. With standard detection 25% of all relapses were evident within the first year of surgery and with ultrasensitive detection the percentage increased to 85.7%. On both assays 334 patients remained free of biochemical recurrence. CONCLUSIONS: Our ultrasensitive PSA assay is useful for early detection of biochemical relapse after radical retropubic prostatectomy. It not only provides the same accuracy as conventional PSA assays but also offers the advantage of detecting recurrence about 300 days earlier. Thus, long-term results of radical retropubic prostatectomy series can be calculated sooner. The clinical impact of this assay will be obvious once curative treatment options are available if applied at the earliest time of evident tumor recurrence.

Follow-Up Studies↗
PubMedDate not supplied

The use of clinical parameters in an interactive statistical package to predict pathological features associated with local failure after radical prostatectomy for prostate cancer.

The capability of an interactive statistical package (ISP) to predict the patients whose pathologic findings at the time of radical prostatectomy for prostate cancer would require postoperative radiation therapy to prevent local failure is investigated. A retrospective review of the clinical pretreatment factors and pathologic findings of 174 patients with adenocarcinoma of the prostate treated from 1989 to 1993 with radical retropubic prostatectomy was performed and served as a knowledge base of the ISP. The pathologic findings of seminal vesicle involvement, gross transcapsular disease, and positive surgical margins are defined as outcomes associated with a high risk of local failure after radical prostatectomy and, thereby, requiring postoperative radiation therapy to decrease this risk. By using the pretreatment clinical factors including prostate-specific antigen (PSA), Gleason score, clinical stage, and endorectal magnetic resonance imaging (MRI) findings as input to the ISP, patients are identified from a test group of 50 cases with known pathologic outcome who would require postoperative radiotherapy to decrease local failure. Low- (0% to 33%), intermediate- (34% to 67%), and high-risk groups (68% to 100%) for pathologic features associated with local failure were predicted accurately (r > .95) by the ISP for the 50 test cases. Factors identified on univariate analysis by the ISP as significant predictors of local failure postoperatively include PSA > 20 (p < .001), clinical stage (p < .001), MRI finding of gross transcapsular disease (p < .001), MRI finding of seminal vesicle involvement (p < .001), and Gleason score (p < .003).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1999

An easy and safe approach to separating Denonvilliers' fascia from rectum during radical retropubic prostatectomy.

PURPOSE: We describe a simple technique for excising Denonvilliers' fascia during nonnerve sparing radical retropubic prostatectomy. MATERIALS AND METHODS: After incision of the perirectal fascia Denonvilliers' fascia is bluntly mobilized off of the rectum digitally and by using an aortic clamp. RESULTS: This technique was used successfully in 200 consecutive cases of nonnerve sparing radical retropubic prostatectomy since 1994 with no rectal injuries. CONCLUSIONS: This procedure guarantees simple and complete excision of Denonvilliers' fascia, which covers the posterior surface of the prostate during nonnerve sparing radical retropubic prostatectomy.

Fascia↗
PubMed1999

[Total prostatectomy--a good option for residual prostate carcinoma after I-125 implantation of external radiotherapy].

OBJECTIVE: To evaluate the results of salvage prostatectomy after previous radiation therapy for locally confined prostate cancer. DESIGN: Retrospective. METHOD: Data were collected from the records of all patients with prostate cancer who underwent salvage prostatectomy after I-125 implantation or external radiation therapy in the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands, 1991-1997. Indications for surgery were: locally confined histologically proven residual cancer, good life expectancy, fit for surgery. Standard preoperative workup was done together with a tumour marker measurement, transrectal ultrasound with biopsy of the prostate and a bonescan. Per- an postoperative complications, pathology result and postoperative PSA were assessed. Progression free survival, overall survival and cancer specific survival were calculated according to the Kaplan-Meier method. RESULTS: 10 patients with a mean age of 67.2 years (range: 57-79) and a median follow up of 78 months (range: 0-89) underwent a total prostatectomy after I-125 implantation (7 patients) or external radiation therapy (3 patients). One patient died after the operation from acute tubular necrosis. One patient developed an internal hernia, requiring surgery. Four patients needed pads during the daytime for stress incontinence for urine. The 5-year progression free survival was 72% (95% confidence interval (95% CI): 44-100), the overall survival was 90% (95% CI: 73-100) and the cancer specific survival was 90% (95% CI: 73-100). No local recurrences were detected. CONCLUSION: The local control and the 5-year survival were good in this selected patient group.

Aged↗
PubMed1999

Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies.

PURPOSE: We update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications. MATERIALS AND METHODS: One surgeon performed anatomic radical retropubic prostatectomy on 1,870 men, using the nerve sparing modification when feasible. We evaluated recovery of erections and urinary continence in men followed for a minimum of 18 months. Patients who were not reliably potent before surgery, did not undergo a nerve sparing procedure, or received hormonal therapy or postoperative adjuvant radiotherapy were excluded from the analysis of potency rates but not of continence rates. Other postoperative complications were evaluated for the entire patient population. RESULTS: Recovery of erections occurred in 68% of preoperatively potent men treated with bilateral (543 of 798) and 47% treated with unilateral (28 of 60) nerve sparing surgery. Recovery of erections was more likely with bilateral than with unilateral nerve sparing surgery in patients less than 70 years old (71 versus 48%, p<0.001) compared with patients with age 70 years old or older (48 versus 40%, p = 0.6). Recovery of urinary continence occurred in 92% (1,223 of 1,325 men) and was associated with younger age (p<0.0001) but not with tumor stage (p = 0.2) or nerve sparing surgery (p = 0.3). Postoperative complications occurred in 10% of patients overall and were associated with older age (p<0.002) but the incidence declined significantly with increasing experience of the surgeon (p<0.0001). There was no operative mortality. CONCLUSIONS: Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in young men with organ confined cancer. Other complications can be reduced with increasing surgeon experience.

Adult↗
PubMed1999

[DRG charge and real cost of a radical prostatectomy: preliminary considerations before a study of cost reduction].

Aim of the work was to evaluate the real cost of a radical prostactemy in comparison with the DRG's tariff rates. This work has been conduct before a next study whose objective is the reduction of the costs. The unitary estimated cost of the radical prostatectomies performed from 1997 to April 1998 in the Urological Division of the Università Cattolica S. Cuore has been extrapolated from the entire clinical activity of the same period. The real cost of an uncomplicated radical prostatectomy was also detected. The estimated cost was Lit. 8,225,872 in comparison to the DRG's tariff rate of Lit. 8,842,000; instead the real cost was Lit. 9,085,407. Forty-seven percent of this sum was for routine care in the Division, while 30% for operating room, 5% for pharmacy, 4% for laboratory and 14% for other items. In our institution an operation of high specialization like radical prostatectomy already performed without any complication is little remunerative. Routine care was the major cost: we think its improvement is the first step in order to contain the expense. In this way we can expect secondarily also a reduction in the days of stay.

Costs and Cost Analysis↗
PubMed1999

Management of stage pTxN+ adenocarcinoma of the prostate: influence of radical prostatectomy on progression-free interval.

BACKGROUND: Whether stage pN+ prostate cancer patients will benefit from radical prostatectomy remains a controversial issue. We assess the impact of radical prostatectomy on a progression-free interval for patients with stage pN+ prostate cancer. METHODS: From October 1990 to June 1997, 25 patients were diagnosed with stage pTxN+ adenocarcinoma of the prostate in our institute. Ten of these patients were treated with radical retropubic prostatectomy (RRP) due to false-negative frozen sections at staging pelvic lymphadenectomy. In 15 patients, radical surgery was discontinued because of grossly enlarged lymph nodes and/or positive frozen section results during staging pelvic lymph node dissection (PLND). All patients received immediate androgen ablation therapy with or without radiotherapy. Serum prostate-specific antigen (PSA) was regularly monitored in all patients. RESULTS: During a median follow-up period of 33 months (range, 15-89 months), eight patients (53%) in the PLND group and two (20%) in the RRP group experienced disease progression as defined by significant elevation of serum PSA concentrations. The median progression-free intervals were 46 and 51 months, respectively. Both univariate and multivariate analyses failed to show statistically significant differences in the progression-free survival between the RRP and PLND groups. CONCLUSIONS: Based on our limited experience, surgical removal of the primary tumor may have only a marginal effect in terms of the progression-free interval for prostatic cancer patients with metastasized pelvic lymph nodes (p = 0.124, log-rank test). The follow-up period was not long enough to evaluate the difference in cancer-specific survival.

Adenocarcinoma↗
PubMed1999

[Update of the morbidity of radical retropubic prostatectomy: retrospective analysis of 100 consecutive operations during the period 1996-1997].

OBJECTIVE: To retrospectively evaluate the morbidity of radical prostatectomy, with the exception of sexual complications, based on a recent single-centre series. MATERIAL AND METHOD: From January 1996 to January 1998, the morbidity of 100 consecutive patients undergoing radical retropubic prostatectomy was compared to the morbidity of the first 150 patients operated by the same technique in our department for the period 1983-1993. The perioperative morbidity was studied retrospectively on case files, while continence was evaluated in the last 50 patients by a self-administered questionnaire. Sexual complications could not be evaluated objectively for methodological reasons and were not addressed in this study. RESULTS: The single operative complication was a rectal injury (1%). The transfusion rate was 31%. The early complication rate was 23% with a major complication rate of 5% (four thromboembolic complications and one gastrointestinal haemorrhage). The most frequent minor complications (18%) were wound abscess (5%). The reoperation rate was 3%. The mean duration of vesical catheterization was 7 days (range: 4-30) and the mean hospital stay was 8 days (range: 5-30). With a mean follow-up of 14 months, 73% of patients are perfectly continent, with no incontinence pads, while 15% of the patients required incontinence pads "as a precaution". Incontinence required implantation of an artificial sphincter in 2 patients (2%). Only one patient developed stenosis of the anastomosis requiring internal urethrotomy. The reduction of morbidity in these 100 recently operated patients compared to the first 150 operated patients concerned the transfusion rate (31% versus 65%), the reoperation rate (3% versus 8%) and the minor complication rate (18% versus 32%). The reduction of operative morbidity partly explains the reduction of mean duration of vesical catheterization (7 days versus 15 days), and hospital stay (8 days versus 18 days); the anastomotic stenosis rate was also decreased from 17.3% to 1%. CONCLUSION: This study confirms the reduction of overall morbidity of retropubic radical prostatectomy. This improvement is probably multifactorial: increased operative experience and better postoperative management. These retrospective data must be taken into account in the diagnostic and therapeutic decisions concerning localized prostate cancer.

Aged↗
PubMed2000

Early post-prostatectomy pelvic floor biofeedback.

PURPOSE: We determined whether biofeedback enhanced pelvic floor exercises begun 6 weeks after radical prostatectomy improve the early recovery of continence. MATERIALS AND METHODS: We randomized 30 patients who underwent radical retropubic prostatectomy into a group that received 5 biofeedback sessions and a control group. RESULTS: Overall 87% of patients were pad-free at 6 months with similar results in the treatment and control groups (86% versus 88%). There was no statistically significant difference in pad test results or voiding diary records in the 2 groups. CONCLUSIONS: A treatment program of biofeedback enhanced pelvic floor exercises begun 6 weeks after radical retropubic prostatectomy did not significantly affect continence in this study.

Biofeedback, Psychology↗
PubMed1999

[Urinary continence after retropubic radical prostatectomy: retrospective study with self-administered questionnaire].

OBJECTIVES: To precisely evaluate the incidence of urinary incontinence after radical prostatectomy and its impact on quality of life. MATERIAL AND METHODS: A self-administered questionnaire was sent to 116 patients operated between 1987 and 1996. Preoperative and postoperative urinary continence, the time until urinary continence was achieved, the presence of urgent micturition, the degree of discomfort caused by urinary incontinence and associated voiding disorders were assessed. RESULTS: The questionnaire response rate was 96.6%. The urinary incontinence rate (continuous use of pads) was 13.4%. No predictive factor for postoperative urinary incontinence was identified. Urge incontinence was present in 31.3% of cases. 85% of patients claimed to be satisfied with the operation and 95.4% declared that they would be willing to undergo radical prostatectomy again. CONCLUSION: The incidence of urinary incontinence after radical prostatectomy is acceptable and the morbidity that it generates is well tolerated and has little impact on quality of life.

Aged↗
PubMed2000

Experience with early catheter removal after radical retropubic prostatectomy.

PURPOSE: We tested the hypothesis that early catheter removal may be accomplished safely after radical prostatectomy. MATERIALS AND METHODS: Cystography on postoperative day 4 or 5 in 42 of 67 consecutive patients who underwent radical retropubic prostatectomy revealed no extravasation in 30 and the urethral catheter was removed (group 1). The control group included 25 patients who did not undergo cystography, and the catheter was removed 14 days postoperatively (group 2). RESULTS: Immediate and late continence was achieved in 14 (46.7%) and 25 (83.3%) cases in group 1, and in 8 (32%) and 22 (88%) cases in group 2, respectively (p>0.05). Catheterization was performed easily without any endoscopic or surgical procedure in 2 patients (6.7%) in group 1 who presented in urinary retention after catheter removal. Wound infection and pelvic abscess developed in 1 case (3.3%). There were no late complications. In group 2 urinary retention developed in 1 patient (4%), wound infection in 1 (4%) and hematuria in 1 (4%). Two patients (8%) had late vesical neck contracture at 4 and 10 months, respectively, which required urethrotomy in 1. In 1 patient (4%) a stricture in the anterior urethra was dilated. CONCLUSIONS: Our study shows that early catheter removal may be accomplished safely in most patients after radical retropubic prostatectomy, and was not associated with a higher complication rate.

Aged↗
PubMed2000

Neurostimulation during radical prostatectomy: improving nerve-sparing techniques.

Considerable variation exists in the reported results of nerve-sparing prostatectomy with respect to potency preservation. This may reflect differences in surgical technique. The Cavermap is a device that uses intraoperative nerve stimulation with real time tumescence monitoring to permit identification of the course of the cavernous nerve fibers during radical prostatectomy. Results of a single center phase 2 and a blinded multicenter phase 3 study have demonstrated an improved outcome compared with conventional nerve sparing with respect to Rigiscan-measured nocturnal erection at 1 year after prostatectomy. The device permits evaluation of the success of nerve-sparing during surgery. Further studies of the effectiveness of the Cavermap device are warranted.

Clinical Trials as Topic↗
PubMed2000

Comparison of patients' and physicians' rating of urinary incontinence following radical prostatectomy.

One of the most important endpoints following a radical prostatectomy focuses on the recovery of urinary continence; however, the reported incontinence rates have been quite variable. In men with prostate cancer, it has been found that the physician's assessment of a patient's symptom does not correlate with the patient's own assessment. To further explore the differences in the reported outcomes between physicians and patients, we evaluated the assessment of urinary incontinence in a cohort of men undergoing radical prostatectomy. A total of 145 individuals completed a brief urinary continence questionnaire postoperatively at the 1-year anniversary of their operation and also had the physicians' assessment of incontinence documented in the medical record. Patient-reported incontinence rates varied from 13% to 65% depending on the definition of incontinence applied and the greatest agreement was seen when the physicians' assessment of incontinence was compared with the patient's report of pad use and urinary bother. These comparisons resulted in only moderate to good levels of agreement, which suggests that a more reliable and accurate means to evaluate urinary incontinence following radical prostatectomy needs to be developed.

Adult↗
PubMed2000

Differences in sexual function and quality of life after nerve sparing and nonnerve sparing radical retropubic prostatectomy.

PURPOSE: We determine the impact of nerve sparing techniques on quality of life after radical retropubic prostatectomy for prostate cancer. MATERIALS AND METHODS: The RAND/UCLA Prostate Cancer Index and several questions about surgical outcomes, including sexual function, were sent to 170 consecutive patients at least 1 year after radical retropubic prostatectomy. Statistical analysis was performed on data for the entire group as well as subgroups of patients after nerve sparing and nonnerve sparing surgery. RESULTS: Nonnerve sparing surgery was performed in 83 of 129 responders (nonnerve sparing group) and the remaining 46 were treated with unilateral nerve sparing surgery (nerve sparing group). Scores for sexual function, sexual bother, physical function and physical limitation domains were significantly better in the nerve sparing group. Spontaneous erectile activity was reported by 50% of nerve sparing group patients. Nerve sparing status did not affect urinary function, bowel function or disease outcome. CONCLUSIONS: Nerve sparing techniques have positive effects on quality of life and sexual function for patients undergoing radical retropubic prostatectomy.

Adenocarcinoma↗