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PubMed1997

Has there been a recent shift in the pathological features and prognosis of patients treated with radical prostatectomy?

PURPOSE: We determined if there has been a significant change in pathological stage or prognosis of patients with clinically localized prostate cancer treated with radical prostatectomy between 1983 and 1995. During this period the methods of detection of prostate cancer changed to include, in recent years, a large proportion of nonpalpable cancers detected by prostate specific antigen (PSA). MATERIALS AND METHODS: The method of diagnosis, pathological features and prognosis (PSA detected progression-free probability) of 754 consecutive patients treated by 1 surgeon for clinical stages T1 to 3NXMO prostate cancer from 1983 to 1995 were analyzed by year of diagnosis. RESULTS: There was a marked increase in the annual number of radical prostatectomies performed with time. The proportion of cancers initially detected by transurethral resection decreased markedly after 1989. Beginning in 1990 nonpalpable cancers detected by PSA increased substantially to 52% by 1995. However, there was no significant change in preoperative serum PSA, tumor volume or pathological stage during the study period. The proportion of patients with well differentiated cancer decreased somewhat, while those with moderate to poorly differentiated (Gleason sum 7) cancers increased significantly after 1991. There was no increase with time in the proportion of patients with a small (less than 0.5 cm.3), well or moderately differentiated (Gleason grades 1 to 3) cancer confined to the prostate (an indolent or clinically unimportant cancer) but fewer patients in recent years had an advanced cancer (established extraprostatic extension with a positive surgical margin, seminal vesicle invasion or lymph node metastases). The actuarial probability of progression after surgery was similar for patients treated from 1983 to 1987, 1988 to 1991 and 1992 to 1995. CONCLUSIONS: Despite marked changes in the number of patients treated each year and the method by which cancers were first detected, we found no change in pathological stage or prognosis (progression rate) for patients treated with radical prostatectomy between 1983 and 1995. Despite concerns that the increased detection of prostate cancer could lead to many more patients being treated unnecessarily for small, indolent cancers, we found no increase in the proportion of such cancers with time.

Actuarial Analysis↗
PubMed1997

Adjuvant therapy for prostate cancer patients at high risk of recurrence following radical prostatectomy.

OBJECTIVE: To identify which patients with prostate cancer are at high risk for local or distant recurrence after radical prostatectomy. METHODS: Review of data from several historical and contemporary series of patients undergoing radical prostatectomy. RESULTS: Patients with high-grade disease (i.e., Gleason score > or = 8), positive margins, and seminal vesicle invasion have relatively high risks of biochemical and clinical failure if no adjuvant therapy is given. Use of radiation therapy may improve local control rates for a subset of these patients (i.e., those with positive margins) but appears to have little impact on the later development of metastatic disease or of prostate cancer death. Hormone therapy may delay the onset of failure for other patients with 'high-risk' disease but there are few data to support its widespread use. CONCLUSIONS: Enhanced ability to predict which patients with high-risk prostate cancer will fail locally after radical prostatectomy is needed. Such patients should then be enrolled in a randomized study of postoperative adjuvant radiation therapy. Similarly, patients predicted to be at high risk for distant failure should be enrolled in trials evaluating conventional and 'novel' forms of hormonal therapy (i.e., potency sparing regimens) to determine whether such therapy delays the time to biochemical or clinical progression without compromising the patient's quality of life.

Androgen Antagonists↗
PubMed1997

A novel technique to prevent Foley catheter loss following radical retropubic prostatectomy.

We describe a method to prevent Foley catheter loss following radical retropubic prostatectomy. In 84 consecutive patients undergoing radical retropubic prostatectomy, a technique of securing the indwelling Foley catheter extracorporeally using a permanent stitch and a sterile button was utilized. No instances of unintended Foley catheter dislodgment were experienced in any of the 84 cases. The extracorporeal button was well tolerated by all patients, and there was no increased incidence of catheter-related complications. This technique provided the additional benefit of balloon volume adjustment in ten patients who experienced bladder spasms. This method is a simple, safe and well-tolerated adjunct to avoid Foley catheter loss following radical retropubic prostatectomy.

Abdomen↗
PubMed1997

Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial.

PURPOSE: This study was aimed at assessing prospectively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy. MATERIALS AND METHODS: A total of 30 potent patients with clinically localized prostate cancer (clinical stage B1 or B2, Gleason sum 7 or greater, prostatic specific antigen less than 20 ng./ml.) underwent nerve-sparing radical retropubic prostatectomy and was subsequently randomized to alprostadil injections 3 times per week for 12 weeks (group 1, 15 patients) or observation without any erectogenic treatment (group 2, 15 patients). Patients were assessed at the 6-month followup by sexual history, physical examination, color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections. RESULTS: In group 1, 12 patients (80%) completed the entire treatment schedule and were evaluated at the long-term followup. Eight patients in this group (67%) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse, compared with 3 patients (20%) in group 2. The difference between the 2 groups was statistically significant (p <0.01). In group 1, all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing, whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them. In these patients, failures were the result of cavernous veno-occlusive dysfunction (2 cases, 17%) and cavernous nerve injury (2 cases, 17%). In group 2, patients with normal erections showed both normal nocturnal testing and penile hemodynamics, whereas failures were the result of cavernous veno-occlusive dysfunction (8 cases, 53%), cavernous arterial insufficiency (2 cases, 13%) or cavernous nerve injury (3 cases, 20%). Complications in patients treated with alprostadil injections accounted for 2 cases (13%) of a penile nodule and 1 further case (6%) of prolonged penile erection. Complications were not seen in group 2 patients. CONCLUSIONS: Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy. It is our belief that programmed vasoactive injections improve cavernous oxygenation, thereby limiting the development of hypoxia-induced tissue damage. The potential complications related to the use of intracavernous injections must be clearly explained to patients.

Aged↗
PubMed1997

Continence, potency and morbidity after radical perineal prostatectomy.

PURPOSE: We investigated continence, potency and morbidity rates associated with radical perineal prostatectomy. MATERIALS AND METHODS: We assessed 220 consecutive men who underwent radical perineal prostatectomy for clinically localized prostate cancer between January 1984 and July 1995. Concomitant pelvic lymphadenectomy was performed in 181 patients. Potency was assessed in a subset of 50 consecutive men with good preoperative potency and a minimum 18-month followup who were otherwise candidates for a nerve sparing procedure (22 bilateral and 28 unilateral). Continence and potency were prospectively evaluated. RESULTS: Continence was preserved in 208 of the 220 men (95%), and it returned in 23% by 1 month, 56% by 3, 90% by 6 and 95% by 10. Advanced age was the only significant risk factor. All 12 incontinent men (5%) were 69 years old or older and they represented 12% of that age group (12 of 103). After nerve sparing potency was preserved in 35 of the 50 fully potent men (70%), returning in 24% by 6 months, 50% by 12, 64% by 18 and 70% by 24. Unilateral nerve sparing preserved potency in 19 of 28 men (68%). There were no deaths but serious morbidity developed in 5 patients (2%). Anastomotic stricture, inadvertent proctotomy and venous thromboembolism occurred in 3 men (1%), respectively. Median operative blood loss was 600 ml. and 208 men (95%) had blood loss of 1,200 ml. or less. Median total hospital stay is now 2 days. CONCLUSIONS: Radical perineal prostatectomy is safe. In our 220 patients there were no deaths and serious morbidity developed in 2%. The continence rate was 95% and 70% of a select group recovered potency.

Adult↗
PubMed1997

Cathepsin D and chromogranin A as predictors of long term disease specific survival after radical prostatectomy for localized carcinoma of the prostate.

BACKGROUND: The accumulation of chromogranin A (Chr A) and cathepsin D (Cath D) gene products may be important in prostate carcinoma progression. This study assessed whether the levels of immunoreactivity for Chr A and Cath D are better predictors of disease specific survival than conventional pathologic parameters of the primary tumor such as Gleason score, capsular penetration, seminal vesicle invasion, and percent tumor in the specimen for patients with clinically localized prostate carcinoma managed by radical prostatectomy. METHODS: Seventy-one patients with modified Jewett clinical stages A1 to B2 adenocarcinoma of the prostate underwent a radical prostatectomy after a negative metastatic workup. No neoadjuvant or adjuvant treatments were given and all disease recurrences and causes of death were recorded. Analysis of prostatectomy specimens was undertaken to determine the conventional pathologic parameters of the primary tumor and Chr A and Cath D immunohistochemical staining. Univariate and multivariate analyses were performed to determine the independent contributions of Chr A and Cath D in predicting survival. RESULTS: On univariate analysis Chr A was the only variable that reached statistical significance for disease specific survival (P = 0.035). Cath D nearly reached significance with a P value of 0.079 for disease specific survival. On multivariate analysis, the only independent factor predicting disease specific survival was the Chr A staining score (P < 0.05). In patients with unequivocal foci of Chr A immunoreactivity, the 14-year disease specific survival was 50% compared with 68% for patients lacking such foci. CONCLUSIONS: The level of Chr A immunohistochemical staining is a strong predictor of disease specific survival and is superior to standard pathologic prognostic factors. Such findings lay the groundwork for future prospective study of the utility of such markers on biopsy specimens to predict patient outcome.

Carcinoma↗
PubMed1997

[Experience with radical prostatectomy as treatment of localized cancer of the prostate at the Fundación Santa Fe de Bogotá, Colombia].

OBJECTIVE: To analyze the experience of the Fundación Santa Fe de Bogotá with radical prostatectomy in the treatment of localized prostatic cancer. METHODS: A retrospective study was conducted on 108 patients with localized carcinoma of the prostate stage T1-T2NxM0 submitted to radical prostatectomy from 1989 to 1994. RESULTS: Preoperatively, 50% of the patients had a PSA < 10 ng/ml and 14% had values that fell within the normal ranges of 0-4 mg/ml. A family history of prostate cancer was detected in 9.3% of the patients. The prostate cancer was clinically understaged in 75% of the patients, particularly those with stages T2a and T2b, and less significantly in those with stage T2c. Considering only those patients in whom the pathological staging had disclosed the cancer was not localized, this incidence accounted for 52% (n = 57). The presence of surgical margins was approximately 36%. The tumor recurrence rate was 26.9% and the complication rate was 6.8%. CONCLUSION: The relatively low complication rate in the present series shows that radical prostatectomy is a safe procedure that achieves good results if the cases are carefully selected and the diagnostic test are widely utilized.

Age Distribution↗
PubMed1998

Therapeutic radiation in patients with a rising post-prostatectomy PSA level.

The optimal management of patients with an elevated post-prostatectomy prostate-specific antigen (PSA) level remains to be determined. In the pre-PSA era, many patients received immediate adjuvant radiation therapy on the basis of adverse pathologic features following prostatectomy. However, since the advent of postoperative PSA monitoring, the PSA level has become the most specific measure for determining the presence of residual disease. An elevated postoperative PSA in correlation with other factors, such as pathologic stage and imaging studies, can be a specific marker of local recurrence in most patients. Through careful case selection, treatment design, and dose delivery, up to 80% of patients can achieve a complete response (PSA < 0.1 ng/mL) following postoperative therapeutic irradiation for an elevated PSA. This treatment can be delivered with minimal toxicity to the rectum and minimal risk of increasing incontinence. Pending the results of randomized trials, an appropriate therapeutic option for high-risk patients following prostatectomy would be to wait for an elevated PSA and then proceed with a course of potentially curative radiotherapy.

Disease-Free Survival↗
PubMed1998

Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer.

PURPOSE: During radical prostatectomy for prostate cancer tumor at the surgical margin is a relatively frequent finding. We summarize the literature on the incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy. MATERIALS AND METHODS: The literature was reviewed for data on positive margins during radical prostatectomy for prostate cancer. RESULTS: Positive surgical margins may result from artifacts induced by tissue processing, incising inadvertently into the prostate or incising into extraprostatic tumor that has extended beyond the limits of resection. Patients with 10 ng./ml. or greater preoperative prostate specific antigen, biopsy Gleason score 7, multiple positive biopsies, or clinical stage T2b, T2c or T3 cancer have a higher risk of positive margins. Preoperative endorectal magnetic resonance imaging may be useful in staging a select group of patients. Neoadjuvant androgen deprivation reduces the incidence of positive margins but does not appear to delay progression or improve survival. The surgical approach, retropubic or perineal, may influence the location and etiology of positive margins. In general, nerve and bladder neck sparing procedures do not compromise tumor removal in appropriately selected patients. Positive margins increase the risk of progression and correlate with decreased cancer specific and overall survival. There is no consensus on the management of positive margins. External beam radiation and androgen deprivation may be administered as adjuvant therapy or at the time of recurrence. CONCLUSIONS: Tumor at the specimen edge is an adverse prognostic factor. With appropriate patient selection and meticulous surgical technique some positive margins can be prevented. Controlled prospective randomized studies of postoperative therapy are needed before definitive recommendations can be made for treating positive margins.

Androgen Antagonists↗
PubMed1998

The early effect of pelvic floor muscle exercise after transurethral prostatectomy.

PURPOSE: We evaluate the early effect of pelvic floor muscle exercise on the frequency of urination, terminal dribbling, urinary incontinence and satisfaction with life in patients after transurethral prostatectomy. MATERIALS AND METHODS: From February to October 1996, 50 patients who had undergone transurethral prostatectomy were selected for study. The first 25 men served as a control group and the next 25 were the experimental group. Pelvic floor muscle exercise was started after removal of the Foley catheter postoperatively in the experimental group. The patients were evaluated before pelvic floor muscle exercise and weekly at our outpatient department after discharge from the hospital. Results for the later 25 patients treated with the pelvic floor muscle exercise program were compared to those of the prior 25 patients. RESULTS: There was a statistically significant difference (p <0.05) in the strength of pelvic floor muscle contractions at 4 weeks, length of between void interval (p <0.01), terminal dribbling at week 4 (p <0.05) and urinary incontinence at weeks 3 and 4 between the 2 groups after pelvic floor muscle exercise. During this study no complication or mortality occurred and there were no cases of hospitalization for either group. After pelvic floor muscle exercise patients in the experimental group had better satisfaction with life than the control group (p <0.01). CONCLUSIONS: We conclude that pelvic floor muscle exercise seems to help reduce symptoms within the first 4 weeks after transurethral prostatectomy, and provides better psychological and social quality of life.

Aged↗
PubMed1998

CD34 immunohistochemical assessment of angiogenesis as a prognostic marker for prostate cancer recurrence after radical prostatectomy.

PURPOSE: We assess the neovascularity of clinically localized prostate cancer by immunohistochemistry using the monoclonal antibody CD34 in an attempt to identify associations between angiogenesis and disease progression following radical prostatectomy. MATERIALS AND METHODS: Microvascularity was evaluated using the CD34 monoclonal antibody in archival paraffin embedded radical prostatectomy specimens from 149 patients followed from 3 to 10 years (mean 6.6). Vessels were quantified by counting a minimum of 2 selected microscopic fields (200x, 0.754 mm.2) from each tumor, area of prostatic intraepithelial neoplasia and prostatic hyperplasia, and given a numerical value representing the microvessel density count. RESULTS: Mean microvessel density count did not vary significantly with age or race. There was a significant association between the count and nuclear grade, Gleason sum and pathological stage. Cox survival analysis shows that microvessel density is significantly related to time to recurrence when considered as a continuous variable (p=0.03) as well as dichotomous variable (p=0.007) (microvessel density count less than 90 and 90 or greater). The 5-year recurrence-free survival was significantly higher for patients with a count less than 90 (71%) than for those with a count 90 or greater (51%) (p=0.006). The 5-year recurrence-free survival was also significantly different when microvessel density was used as a continuous variable (p=0.02). Controlling for stage, Gleason sum, race and nuclear grade, microvessel density remained significant in predicting recurrence (p=0.03) but when pretreatment prostate specific antigen was included in the model the count was no longer significant. The microvessel density count in the tumor area significantly increased with increasing Gleason sum and nuclear grade but it did not increase significantly in the adjacent benign prostate or areas of prostatic intraepithelial neoplasia in the same specimen. CONCLUSIONS: Microvascularity or neovascularity as measured by the CD34 antigen may be a prognostic marker of recurrence for prostate cancer patients after radical prostatectomy but more study in prostate specific antigen era patients with sufficient followup is needed.

Age Factors↗
PubMed1998

The greatest dimension of prostate carcinoma is a simple, inexpensive predictor of prostate specific antigen failure in radical prostatectomy specimens.

BACKGROUND: Tumor volume in radical prostatectomies can be determined by several different techniques and appears to predict clinical progression. Greatest tumor dimension and area are easily obtained measures that are both correlated with tumor volume. The authors sought to determine whether greatest tumor dimension and/or area were predictors of prostate specific antigen (PSA) failure in men who underwent radical prostatectomy for adenocarcinoma of the prostate. METHODS: Fifty-seven men with prostate carcinoma who underwent surgical resection were followed for a median of 27.2 months (range, 1-112 months); 24 (42%) of these men had PSA failure. Preoperative PSA, Gleason grade, pathologic stage, margin status, and greatest tumor dimension and area were determined, and both univariate and multivariate analyses of the outcomes of PSA failure were performed. RESULTS: In the univariate analysis, larger values of greatest tumor dimension and area were strongly associated with increased incidence of PSA failure (P = 0.0001 and 0.0011, respectively). The forward stepwise multivariate analysis indicated that greatest tumor dimension had marginal statistical significance as a risk factor for PSA failure (P = 0.0577; risk ratio, 1.117). However, in this series, men with a greatest tumor dimension of less than 1 cm did not experience failure, whereas all patients with a greatest tumor dimension of more than 2 cm did. CONCLUSIONS: Measuring greatest tumor dimension is a simple, inexpensive predictor of PSA failure in men who have undergone radical prostatectomy.

Adenocarcinoma↗
PubMed1998

[Application of radical prostatectomy for prostate cancer and its outcome].

The proportion of patients with localized prostate cancer treated by radical prostatectomy is increasing rapidly in Japan. As for the qualifications of patient candidates for radical surgery, various clinical and pathological findings to predict tumor extent and disease-free outcome must be considered carefully. There has been increased interest in the application of neoadjuvant or adjuvant therapy for locally advanced tumor group in order to improve disease-free survival and overall survival. The new anatomical approach to radical prostatectomy with its nerve sparing option assures preservation of erection. This procedure achieves excellent cancer control for patients with a definite organ-confined tumor preoperatively. Finally, more time is needed to obtain information on the long-term outcome after radical prostatectomy.

Aged↗
PubMed1998

Transient lower extremity neurapraxia associated with radical perineal prostatectomy: a complication of the exaggerated lithotomy position.

PURPOSE: We assess the incidence and risk factors associated with lower extremity neurapraxia following radical perineal prostatectomy. MATERIALS AND METHODS: The medical records of 111 consecutive patients undergoing radical perineal prostatectomy at Duke University Medical Center between June 1994 and June 1995 were retrospectively reviewed. Patients were interviewed by telephone to ascertain whether symptoms had resolved. RESULTS: Neurapraxia developed in 23 patients (21%). Symptomatology was variable, including sensory and motor deficits of the lower leg and foot. Although lower extremity neurapraxia occurred in a significant number of patients undergoing radical perineal prostatectomy, it appeared to resolve in most. CONCLUSIONS: Careful attention to detail when positioning the patient and limiting the time in the exaggerated lithotomy position appear to be the most critical aspects to prevent neurapraxia.

Aged↗
PubMed1998

Predicting the pathology results of radical prostatectomy from preoperative information: a validation study.

BACKGROUND: There are now over 13 published models for predicting the outcomes of radical prostatectomy using preoperative information. Because their ability to predict the pathology of the prostatectomy is key in deciding who benefits the most from this surgery, it is important to know how well these models work for new data. METHODS: The patients in this study were 100 men diagnosed with prostate carcinoma in the prostate specific antigen (PSA)-based screening program at Washington University Medical Center. To test the models, the authors used preoperative information and the published algorithms to predict postoperative pathology outcomes. Statistical methods included plots of predicted probability against observed probability, boxplots of predicted probability against observed outcomes, logistic regression, and linear regression. RESULTS: Although none of the published models predicted the outcomes of radical prostatectomy perfectly, those that predicted tumor volume performed best, and in general those that were multivariate also performed best. Nevertheless, the ability of any of these models to discriminate binary outcomes was not very great. CONCLUSIONS: The results of this study suggest that preoperative variables based on serum PSA and the results of needle biopsies can be used in multivariate models to predict tumor volume, but these models need to be improved. Predicting locally advanced tumor stage is likely to be more difficult and may require information beyond what needle biopsies can provide.

Aged↗
PubMed1991

Prostatic duct adenocarcinoma. Findings at radical prostatectomy.

Previous studies of prostatic duct adenocarcinoma have reported a poor prognosis, but they included few patients treated by radical prostatectomy. The authors studied 15 cases treated with radical prostatectomy to define more completely their pathologic features and determine the clinical outcome in these surgically treated patients. The study included morphometry and DNA image analysis using the CAS-200 system. The most common presentation was urinary outlet obstruction (n = 9), and most patients were clinical Stage B with palpable prostatic lesions (n = 12). Compared with acinar cancers of similar clinical stage, duct cancers were large (tumor volume, 8.4 +/- 10.0 cc) and occupied a large portion of the gland (23 +/- 21%). Duct cancers were in an advanced final pathologic stage with 93% having capsular penetration, 47% positive margins, 40% seminal vesicle invasion, and 27% positive pelvic lymph nodes. The DNA analysis on cells disaggregated from paraffin revealed that 54% of cases were diploid, 15% tetraploid, 8% aneuploid, and 23% tetraploid/aneuploid. On clinical follow-up, eight patients had no evidence of tumor at intervals ranging from 1 to 28 months, and seven patients (47%) had persistent tumor at intervals of 3 to 18 months. This study demonstrates that duct cancers are in an advanced pathologic stage by the time of presentation and have a much higher short-term failure rate after radical prostatectomy compared with acinar cancers.

Adenocarcinoma↗
PubMed2001

Adjuvant radiotherapy following radical prostatectomy is more effective and less toxic than salvage radiotherapy for a rising prostate specific antigen.

Despite the trend toward earlier diagnosis of adenocarcinoma of the prostate, approximately 25% of men undergoing radical prostatectomy will have pathologic evidence of cancer extending outside of the prostate. These patients are at high risk for subsequent recurrence. Such relapses are almost always manifested initially as a rise in the Prostate Specific Antigen (PSA). Currently utilized PSA assays, however, will not detect a recurrence smaller than 10(7) to 10(8) cells, nor does PSA identify the site of recurrence. In contrast, the pathologic findings at the time of surgery can be used to reliably distinguish patients at risk for local recurrence from those more likely to fail distantly. Furthermore, adjuvant pelvic radiotherapy after prostatectomy, given to patients with an undetectable PSA who are at high risk for local recurrence, results in a higher disease free survival and fewer side effects than if radiotherapy is delayed until the PSA begins to rise. Thus, patients at high risk for local failure following radical prostatectomy, but at low risk for distant metastases (i.e., those with positive surgical margins and an undetectable PSA) should be offered immediate adjuvant radiotherapy.

Adenocarcinoma↗
PubMed2005

[Incidental carcinoma of the prostate: can we and should we recommend radical prostatectomy?].

INTRODUCTION: There is controversy regarding tumor control of incidental prostate cancer (PC). We evaluated in a large cohort if we can recommend radical prostatectomy after TURP. MATERIAL AND METHOD: In 52 (4.3%) from a total of 1207 patients undergoing radical prostatectomy the diagnosis had been made by TURP. In a retrospective analysis we evaluated morbidity, histopathological results, and tumor control of pT1a/b tumors. RESULTS: The number of incidentally detected PC decreased with time. In 5.8% in the TURP group and in 0.5% of the needle biopsy group, there was no residual tumor found (p<0.001). Morbidity was similar +/- TURP with the exception of operation time (206 vs 188 min) and catheter duration (19.3 vs 17.3 days). Postoperative continence was identical. There was no difference in tumor control for local recurrence-free survival and PSA-free survival with and without TURP. CONCLUSIONS: The rate of incidentally detected PC by TURP decreases over time, but in almost all cases we found clinically relevant cancer. TURP is not an adverse prognostic factor and morbidity is similar compared with patients who were diagnosed by needle biopsy. Our data confirm that we should recommend radical prostatectomy to patients who are candidates for further curative therapy.

Aged↗