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PubMed1992

[Systematic morphometry of radical prostatectomy samples. A guideline for general practice].

The predictive value of quantitated tumor volume for the prognosis of the individual patient with prostate cancer has been established in analysis of more than 500 radical prostatectomy specimens at Stanford Medical Center. The Stanford technique for detailed tissue sectioning involves considerable time and expense plus computer planimetry. Therefore we have developed two simplified protocols which are suitable to routine diagnostic pathology. Histologic slides of 145 radical prostatectomy specimens, as evaluated by the Stanford technique, were reviewed and a selection of slides was made in a systematic fashion according to two protocols ("bilateral" and "parasagittal"). Tumor volume was estimated manually from this reduced sample of slides by comparing cancer areas to a millimeter grid. The bilateral protocol used an average of 11.7 slides per case (range 8-20), the parasagittal protocol used an average of 8.8 slides per case (range 6-15) versus an average of 26.2 slides per case (range 16-67) by the original Stanford technique. Volume estimates were within +/- 20% of true (computer) volume in 96% and 89% of cases, respectively. A simplified tissue sampling technique can yield accurate cancer volume determinations in radical prostatectomy specimens with reduced time and expense.

Histological Techniques↗
PubMed2003

[How to present in a unique fashion the oncologic and functional results after radical prostatectomy].

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA and continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence or absence of biochemical progression (PSA > 0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a socre classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0 + 0 + 0): no cancer control-incontinence-impotence to 7 (4 + 2 + 1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or = 4 had good cancer control, wit no functional disorders for a score of 7 (4 + 2 + 1) (92%), no disorders of continence for a score of 6 (4 + 2 + 1) (31.5%), no disorders of erection for a score of 5 (4 + 0 + 1) (8.3%), or with incontinence and impotence for a score of 4 (4 + 0 + 0) (21.9%). All patients with a score < 4 had a PSA > 0.2 ng/ml, but with no functional disorders for a score for 3 (0 + 2 + 1) (2.4%), no incontinence for a score of 2 (0 + 2 + 0) (8.3%), and no impotence for a score of 1 (0 + 0 + 1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (socre 0 = 0 + 0 + 0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗
PubMed2003

Laparoscopic radical prostatectomy: a review of techniques and results worldwide.

Laparoscopic radical prostatectomy (LRP) is currently performed in multiple centers world-wide, with several different surgical approaches and techniques utilized. A comprehensive review of the published literature worldwide on laparoscopic radical prostatectomy was performed to outline the evolution of this technique, and to review the published surgical, oncological and functional results. A systematic review of peer reviewed articles concerning laparoscopic radical prostatectomy was obtained using Medline query. LRP is being performed in multiple centers worldwide, using a variety of surgical approaches and technologies. Analysis of perioperative parameters, including surgical blood loss, operative time, complications and convalescence, demonstrates a low morbidity and shows a clear trend in improvement with increased experience. The functional results, as recorded by postoperative urinary and sexual functions, appear encouraging. The reported positive surgical margin rates decrease with more recent series. Oncological results and cancer control rates as measured by PSA recurrence and disease-free intervals are difficult to ascertain in the immature series published to date. LRP has witnessed tremendous popularity and widespread implementation in specialized centers worldwide. LRP represents a technically demanding laparoscopic procedure with a difficult learning curve, but can be performed systematically with standard techniques. The advantages include shorter convalescence and markedly lower operative blood loss, with quicker removal of the urinary catheter. Long-term functional and oncologic results are not yet available.

Global Health↗
PubMed2003

Correlation between the Gleason scores of needle biopsies and radical prostatectomy specimens.

BACKGROUND: The Gleason score has been shown to offer important information with regard to prognosis and therapy for patients with adenocarcinoma of the prostate gland. In this study, Gleason scores, as determined by 18-gauge core needle biopsies, were compared with both Gleason scores and the pathological staging of corresponding radical prostatectomy specimens. METHODS: Records of 78 consecutive patients undergoing a radical retropubic prostatectomy between 1998 and 2002 were reviewed. In total, 78 patients were enrolled, all of whom had been diagnosed with adenocarcinoma by transrectal needle biopsies using an 18-gauge automated spring-loaded biopsy gun. RESULTS: Grading errors were greatest with well-differentiated tumors. The accuracy was 6 (23%) for Gleason scores of 2-4 on needle biopsy. Of the 36 evaluable patients with Gleason scores of 5-7 on needle biopsy, 28 (78%) were graded correctly. All of the Gleason scores of 8-10 on needle biopsy were graded correctly. Eighteen (33%) of 54 patients with a biopsy Gleason score of < 7 had their cancer upgraded to above 7. Tumors in 6 patients (60%) with both a Gleason score < 7 on the needle biopsy and a Gleason score of 7 for the prostatectomy specimen were confined to the prostate. CONCLUSION: The potential for grading errors is greatest with well-differentiated tumors and in patients with a Gleason score of < 7 on the needle biopsy. Predictions using Gleason scores are sufficiently accurate to warrant its use with all needle biopsies, recognizing that the potential for grading errors is greatest with well-differentiated tumors.

Adenocarcinoma↗
PubMed2004

[Combined open prostatectomy and preperitoneal inguinal herniorrhaphy: a 21-case report].

OBJECTIVE: To evaluate the effect of simultaneous open prostatectomy and preperitoneal inguinal herniorrhaphy. METHODS: Twenty-one patients with benign prostatic hyperplasia(BPH) and inguinal hernia, underwent simultaneous suprapubic or retropubic prostatectomy and preperitoneal inguinal herniorrhaphy through Pfannenstiel's incision. In 4 cases with bigger inguinal mass, hernia repair was performed with polypropylene meshwork (PPM). RESULTS: The 21 patients were followed up for 6 months to 7 years. There were 2 cases of recurrence (9.5%), with no morbidity and mortality in the other 19 cases. CONCLUSIONS: Open prostatectomy and preperitoneal inguinal herniorrhaphy can be performed during the same session without increasing infection and recurrence. The operation method is simple and the effect is positive, especially for older men.

Aged↗
PubMed2004

The impact of radical prostatectomy on patient well-being: a prospective urodynamic study focused on detrusor function.

Prostate cancer is common in aged men and radical prostatectomy is established as a therapeutic measure. However, to date there is little information about its impact on voiding function. We conducted a prospective clinical study to elucidate the impact of radical prostatectomy on voiding function in 17 patients with prostate cancer, by urological evaluation including filling and voiding cystometry (pressure flow study). The patients who were estimated as having weak detrusor function including very weak detrusor function at 3 months postoperatively had significantly more frequent urinary incontinence compared with the others (p < 0.05). Of 8 patients who showed urinary incontinence for more than 3 months, 7 (88%) patients developed weak detrusor function at 3 months after operation, but 4 of them were estimated as having normal detrusor function preoperatively. These patients revealed reduced maximum flow rate and significantly increased quality of life score compared with the other patients (p < 0.05). An initially reduced bladder compliance disclosed a tendency to a rapid return to normal with time after surgery. Detrusor overactivity itself and neoadjuvant antiandrogen therapy were not related to prolonged postoperative urinary incontinence. The present study indicates that caution is required when administering medication that could potentially affect detrusor function, regardless of the type of preoperative detrusor function, in patients with persistent urinary incontinence or a reduced urinary stream. Particular emphasis is laid on the importance of urodynamic assessment of post-prostatectomy detrusor function and appropriate management modalities based on the results.

Aged↗
PubMed2004

[Preliminary results in a series of patients with prostate cancer who underwent radical prostatectomy].

OBJECTIVES: To analyze the preliminary results in our series of radical retropubic prostatectomies (RRP) in terms of complications; and to evaluate also its efficacy in disease control (cancer progression and survival). METHODS: We reviewed the charts of 139 patients who underwent radical prostatectomy. Preoperative data such as age at the time of diagnosis, serum PSA, presence of suspicious digital rectal examination (DRE), clinical stage, and Gleason's score on biopsy. Complications noted after RRP were studied. Survival analysis (Kaplan-Meier) was performed to study clinical and biochemical progression in relation to factors such as baseline PSA, pathologic Gleason's score, pathologic stage, affected surgical margins and capsular penetration. Univariate comparison of factors was performed using the log-rank test. Multivariate analysis (Cox model) was also carried out to identify predictive variables (or risk factors) for progression. RESULTS: 127 patients were available for progression assessment (91.4%). Overall, 19 complications were registered in the immediate postoperative period. 89 patients (91.8%) stated being continent in their last follow-up visit. Complete erectile dysfunction (ED) was noted in 74 patients (76.3%), partial ED in fifteen (15.5%), and 8 (8.2%) reported not they have not problems with their erectile function after surgery. Thirty-four patients (26.8%) presented biochemical progression, being the mean time to progression for the whole series 5.8 years (standard error 0.38). 2 and 5-year probability to remain free of biochemical progression were 71.2% and 58.8%, respectively. Only preoperative PSA (p = 0.023) and Gleason's score in the surgical specimen (p = 0.001) were identified as predictive variables for biochemical progression on the univariate analysis (log-rank). CONCLUSIONS: Radical prostatectomy offers acceptable results in terms of tolerability and short and mid-term survival. Preoperative PSA or Gleason's score in the surgical specimen may help to predict subsequent outcome of the disease.

Adult↗
PubMed2004

Clinical results of combined epidural and general anesthesia procedure in radical prostatectomy management.

OBJECTIVES: Improvement of radical prostatectomy surgical technique remains an objective for urological practice. The aim of this study was to evaluate the potential benefit of intra and postoperative epidural versus general anesthesia alone. MATERIAL AND METHODS: The authors retrospectively analyzed 62 consecutive cases of patients who underwent radical retropubic prostatectomy over a 2-year period. The mean age was 65.5 years (51-75). Two groups were selected: group I = 19 patients, who received epidural anesthesia in association with general anesthesia and group II = 43 patients with general anesthesia alone. Both groups were similar for ASA score, Body Mass Index, prostate volume, tumor stage and Gleason score. Evaluation criteria were operative time, blood loss, postoperative pain (analgesics required) and length of hospital stay. Mono and multifactorial statistical analysis were performed. RESULTS: Operative time in group I was 189 mn versus 218 mn for group II (p = 0.01). Significant difference was found independent of surgical experience. Moreover, significant blood loss (p = 0.002) was observed: 971 ml in group I versus 1840 ml in group II. Also, less blood was transfused during surgery in group I: 0.84 blood units transfused versus 2.60 blood units in group II (p = 0.007). In both groups, hematocrit level remained stable during surgery. As regards postoperative pain, an improvement in required analgesic level was noted in group I during the initial 48 hours (p = 0.001 for day 1; p = 0.032 for day 2). Finally, mean hospital stay was only 9.3 days in group I and 12.4 days in group II (p = 0.005). CONCLUSION: Our study suggests that improved results can be obtained when epidural anesthesia is associated with general anesthesia in radical retropubic prostatectomy intra and postoperative management, with a significant reduction in morbidity.

Anesthesia, Epidural↗
PubMed2004

[Perineal radical prostatectomy as monotherapy: ten-year experience].

OBJECTIVES: To evaluate the clinical and oncological results of perineal radical prostatectomy (PRP) as monotherapy. METHODS: We include our initial series of 115 consecutive patients with prostate cancer without neoadjuvant hormonal therapy undergoing perineal radical prostatectomy as monotherapy from November 92, when we decide to abandon laparoscopic lymphadenectomy in patients deemed at low risk of N+ (PSA = 10 and Gleason score = 7 and organ confined or suspicion of minimal extra capsular extension on ultrasound). Functional results are compared with the first 115 consecutive patients in our own series of retropubic radical prostatectomy (RRP). No patient received adjuvant therapy and deferred intermittent androgen blockade was only applied when patients with biochemical progression reached a PSA of 4 ng/ml. RESULTS: After a mean follow-up of 57.7 months (3-130) we obtained: global survival 98.3%, disease specific 100%; biochemical progression 13.9% (161, pT 2 (5.2%), 32pT3a (21.8%), 7pT3b-pT4a (71.4%)). Incidence of positive margins 41.7% (52.1% unifocal with a progression rate of only 12%). 87% of the patients did not need transfusion during or after surgery. Urinary continence was 96.5% and the probability of potency preservation was 34.7%. Among 16 patients with biochemical progression, only 4 required deferred intermittent androgen blockade (1 cycle in 3 patients and two in the remainder). CONCLUSIONS: PRP without lymphadenectomy as monotherapy offers excellent oncological and functional results equivalent to RRP, which favour the perineal approach: short-term operative times, lower transfusion rate, possibility of regional anesthesia, better tolerance with minimal analgesia requirements, and shorter hospital stay. Watchful waiting in the follow-up of patients in biochemical progression with a deferred intermittent androgen blockade regimen offers an excellent quality of life, with survivals similar to any other therapeutic option after this follow-up time.

Aged↗
PubMed2004

[The effect of radiotherapy on patients with prostate specific antigen failure after radical prostatectomy].

We studied the effect of radiotherapy on patients with re-elevation of prostate specific antigen (PSA) after radical prostatectomy. Radiotherapy was performed on 8 patients with re-elevated PSA after radical prostatectomy without any previous treatment. Pathological stages were B in 2 patients, and C in 6 patients. Patients received three-dimensional dynamic conformal radiotherapy, and irradiation doses ranged from 44 to 70 Gy (median 60). The target area of irradiation included prostatic bed and seminal vesicles. PSA levels before radiotherapy were 0.31-1.9 ng/ml (median 0.40). In 7 patients, PSA levels decreased and no increase has been observed thereafter. In one patient, PSA level increased during radiotherapy; therefore, the treatment was discontinued at 44 Gy. Two patients suffered grade 1 to 2 acute toxicities, and no late toxicity has been observed so far. Radiotherapy is considered one of the effective treatments for re-elevation of PSA after radical prostatectomy.

Aged↗
PubMed2004

[Questionnaire and pad-test in assessment of incontinence after radical retro-pubic prostatectomy].

OBJECTIVE: To confirm urinary incontinence after radical retro-pubic prostatectomy by questionnaire and pad-test, observe the influence of radical prostatectomy on the patient's quality of life (QOL), and study the effect of urethral sphincter preservation and the patient's age on incontinence. METHODS: Questionnaire and pad-test were conducted in 165 consecutive prostate cancer patients who underwent radical prostatectomies. The mean follow-up time was 13 months (12-14 months). Each patient was kept in contact with our incontinence advisor by telephone or direct interview. At 12 months after operation, the patients were asked to the clinic to fill in the questionnaire and underwent the pad-test. In accordance to different operative techniques, the patients were divided into a sphincter repairing group (19 cases) and a sphincter preservation group (146 cases). RESULTS: All the 165 patients were kept in contact with us, underwent the pad-test and filled in the questionnaire. Of the 7 patients diagnosed as incontinence for admitting using pads, only 1 had urinary leakage, and the other 6, who did not use pads very often, showed slight change of QOL. In the pad-test, 5 patients were considered to be incontinent since the pad weight gained > 1 grams. Between the questionnaire and the pad-test there was a high concordant rate (98.8%). Within 3 months after operation, younger patients seemed to return to continence sooner. The continence rate at 12 months after operation was 99.3% in the sphincter preservation group and 94.7% in the sphincter-repairing group. The incontinence rates at the removal of the urinary catheter after operation were 60% and 82% in patients aged 51-60 and 61-70, respectively. At 3 months after operation, the incontinence rates were similar in both groups. CONCLUSION: Both the questionnaire and the pad-test are recommendable in the assessment of post-operative incontinence since it can accurately document patients' incontinent status. Preservation of the urethral sphincter and its possible innervations can improve the incontinence rate. Younger patients seem to return to continence sooner than the elders.

Adult↗
PubMed2004

Comparing radical prostatectomy and brachytherapy for localized prostate cancer.

Radical prostatectomy and ultrasound-guided transperineal brachytherapy are both commonly used for the treatment of localized prostate cancer. No randomized trials are available to compare these modalities. Therefore, the physician must rely on institutional reports of results to determine which therapy is most effective. While some investigators have concluded that both therapies are effective, others have concluded that radical prostatectomy should remain the gold standard for the treatment of this disease. This article reviews the major series available for both treatments and discusses the major controversies involved in making these comparisons. The data indicate that for low-risk disease, both treatments are effective, controlling disease in over 80% of the cases, with no evidence to support the use of one treatment over the other. Similarly, for intermediate-risk disease, the conclusion that one treatment is superior to the other cannot be drawn. Brachytherapy should be performed in conjunction with external-beam radiation therapy in this group of patients. For patients with high-risk disease, neither treatment consistently achieves biochemical control rates above 50%. Although radical prostatectomy and/or brachytherapy may play a role in the care of high-risk patients in the future, external-beam radiation therapy in combination with androgen deprivation has the best track record to date.

Biomarkers, Tumor↗
PubMed2004

Laparoscopic radical prostatectomy--analysis of our first 100 consecutive cases.

The aim of this study was retrospective study of our first 100 consecutive cases of prostatic cancer, operated by laparoscopic approach and comparison with 100 cases of open retropubic radical prostatectomy (RRP) at our department, focusing on operative data and morbidity. From June 1999 to August 2003 we have performed first consecutive 100 laparoscopic radical prostatectomies (LRP), all according to Montsouris technique. In this study we have compared the results with 100 patients who underwent from May 1997 to August 2003 open RRP. Mean operative time was shorter after RRP (155 vs. 234 min, p = 0.018). Mean blood loss was significantly lower in LRP group (446 vs. 710 ml, p < 0.001). Mean catheter duration time (6.4 vs. 10 days, p < 0.001) and hospital stay (8.6 vs. 11 days, p < 0.001) were significantly shorter in LRP group. There was no statistically significant difference in complication rate in both groups (p = 0.139). Laparoscopic radical prostatectomy is a safe procedure for the patient and complications do not appear more often than in the open operation. In LRP we detected shorter mean catheter duration time, shorter hospital stay and less blood loss. This procedure demands perfect knowledge of the laparoscopic operative technique and due to long-term learning curve, the procedure could be done only in particular centers, where exist suitable equipment and also experienced operators in laparoscopic technique.

Aged↗
PubMed2004

[Biochemical failure after radical prostatectomy].

An elevated or detectable serum PSA after radical prostatectomy for prostate cancer is significant in the great majority of the cases with recurrent or persistent disease. Elevation of serum PSA causes concern for the patient and his physician since the best way to treat these patients is yet unknown. Analysis of large series of patients who underwent radical prostatectomy demonstrates that as many as 30% of patients will experience biochemical relapse represented by elevation of serum PSA. Most of the relapses occur in the first 5 years. However, 10 to 15 years are necessary to ascertain the true clinical progression rate of prostate cancer after radical prostatectomy. The time lag between the biochemical and clinical manifestation of metastatic disease may extend for up to 8 years, followed by an additional 5-year median time until cancer specific death. Radiation therapy may be beneficial as an adjuvant or early salvage if PSA < 1.5 ng/ml and for patients with high probability of local recurrence. Early salvage radiation therapy is a more acceptable option than adjuvant radiation therapy, saving 70% of patients with adverse pathology unnecessary treatment. Hormonal treatment at the time of biochemical relapse is justified in selected patients.

Humans↗
PubMed2005

[Radical prostatectomy with neoadjuvant hormone therapy for cT3 prostate cancer].

The efficacy of neoadjuvant hormone therapy and radical prostatectomy for cT1-2 prostate cancer have been reported to be negative from some randomized prospective studies. On the other hand, radical prostatectomy alone for cT3 prostate cancer is understood as out of indication because of high rate of positive surgical margin and PSA failure. Several investigators have examined the role of neoadjuvant hormone therapy before radical prostatectomy for cT3 prostate cancer to improve outcome. This document was reviewed the literature whether neoadjuvant hormone therapy is beneficial or not, for organ confined prostate cancer and for locally advanced prostate cancer, and presented our extended resection of prostate with neoadjuvant hormone therapy is improved the results in cT3 prostate cancer.

Antineoplastic Agents, Hormonal↗
PubMed2005

[Quality of life after radical prostatectomy].

Prostate cancer is increasingly detected at early stages and patients can choose various forms of treatment which have favorable survival outcomes. Radical prostatectomy is a major procedure for treating early stage prostate cancer curatively. The instruments of measuring health related QOL (HRQOL) accurately for early prostate cancer treatment were developed. Some of the instruments were useful in Japan after translating into Japanese and pilot testing. Many authors have reported QOL data after radical prostatectomy. These data suggested that general and urinary domains of HRQOL recovered rapidly after radical prostatectomy, but recovery of sexual domains of HRQOL took longer. Recently several authors have reported that HRQOL were affected with ethnic and cultural differences. These results strongly suggested a need for longitudinal surveys in Japanese patients.

Humans↗
PubMed2004

[Radical prostatectomy with transurethral dissection of the prostate and seminal vesicles].

Transurethral dissection of the prostate and seminal vesicles was performed as the first step of suprapubic radical prostatectomy. Dissection was performed with a two-channel resector. Release of the anterior surface of the seminal vesicles and ampullae of the vas deferens was started at the bladder neck, in an infratrigonal plane. Partial section of the urethra was then performed proximally to the striated sphincter under visual and digital control to release the posterior surface of the prostate and seminal vesicles. Transurethral preparation of radical prostatectomy is technically feasible on the basis of our brief experience. This type of endoscopic prostatovesicular dissection avoids traction on the prostate, and theoretically decreases the risk of damage to the neurovascular pedicles (erection preserved in 6 out of 10 patients). Similarly, endoscopic section of the urethra theoretically decreases traumatic lesions of the striated sphincter (continence after removal of the bladder catheter in 9 out of 10 patients). The oncological result and operating time were comparable to those of conventional suprapubic radical prostatectomy. The risk of absorption is negligible in our experience. A large series is obviously necessary to confirm whether this technique constitutes a real improvement, particularly in terms of preservation of continence and erection.

Feasibility Studies↗
PubMed2005

[Extraperitoneal laparoscopic radical prostatectomy: a report of 2 cases].

OBJECTIVE: To probe into the operation method and clinical result of extraperitoneal laparoscopic radical prostatectomy. METHODS: Two male patients of prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy. The main operation procedures proceeded under the extraperitoneal laparoscope, consisting of dissecting the prostate gland, cutting the bladder shank and the apix of the prostate gland, and then freeing the seminal vesicles followed by removing the prostate anteriorly. The final step was to connect the urethra and bladder neck. RESULTS: The operation time was 10 and 7 hours and blood loss was 1 000 and 500 ml respectively. The intestinal function resumed 24 hours after the operation. The catheter was removed 3 weeks after surgery and no complication was seen. CONCLUSION: Extraperitoneal laparoscopic radical prostatectomy is a good and least invasive method for local prostate cancer.

Aged↗