Outcome and complications of radical prostatectomy in patients with PSA <10 ng/ml: comparison between the retropubic, perineal and laparoscopic approach

Abstract

The objective of this work was to evaluate the oncological outcomes and complications of prostate cancer patients with prostate specific antigen (PSA) < 10 ng=ml after radical prostatectomy by retropubic, perineal and laparoscopic approach. From 1988 to 2001, 306 patients with PSA < 10 ng=ml underwent radical prostatectomy by the retropubic, perineal or laparoscopic approach. Mean operative time, complication rates, length of hospital stay, catheterization time and pathological results were reviewed. Kaplan-Meier analysis was used to evaluate the likelihood of biochemical PSA recurrence. There were no statistical differences between the three groups in terms of preoperative characteristics except for PSA levels (5.5, 6.5 and 6.6 ng=ml for the retropubic, perineal, and laparoscopic approach, respectively, P < 0.05) and for the T1c stage prevalence (50%, 43.1% and 68.4%, P < 0.05). Operating time was significatively longer in the laparoscopic approach (266 min), whereas transfusion rate (22.1%), bladder catetherization (12.1 days), and length of hospital stay (12.1 days) were higher in the retropubic group (P < 0.05). The percentage of medical and surgical complications were 6.9%, 3.1% and 3.4% (P < 0.05) and 18.6%, 16.9% and 11.6% (P < 0.05) for the retropubic, perineal, and laparoscopic approach, respectively. Pathological staging revealed pT2 in 76.7%, 78.4% and 81.3% for retropubic, perineal and laparoscopic approach, respectively (P < 0.05). Positive surgical positive margins were noted in 20.9%, 18.4% and 20.6% (P > 0.05). The actuarial 3-year recurrencefree survival rate was 89.3%, 89.2% and 86.2% (P > 0.05) for retropubic, perineal and laparoscopic approach, respectively. It can be concluded that in patients with preoperative PSA < 10 ng=ml, clinical outcome and complication rates were similar, regardless of the choice of surgical approach.

Robot-assisted radical perineal prostatectomy: first experience of 15 cases

“…Most urologists advocate that patients who have localized PCa do not need definitive treatment. [13] There is not yet a classification that assesses which cancers need or do not need definitive treatment. [14] RPP is a well-defined and successful technique for organ-confined disease.…”

Management of Complications of Prostate Cancer Treatment

“…These procedures, in experienced hands, appear to yield equivalent oncologic outcomes. [2][3][4][5][6][7][8][9] The ultimate decision as to which surgical approach should be used depends on several factors, including surgeon skill and comfort level with a particular approach; the patient's body habitus; comorbidities; previous surgical history; and, perhaps most importantly, the preoperative Gleason score and preoperative staging.…”

Funktionelle Ergebnisse unterschiedlicher Operationstechniken der radikalen Prostatektomie

“…Weit >90% aller Patienten mit organbegrenzten Tumoren weisen ein rezidivfreies Überleben nach 5 Jahren auf.Für die laparoskopische Operation liegen noch keine längerfristigen Verlaufsbeurteilungen vor,die bisher vorliegenden Arbeiten lassen jedoch ein den offenen Operationsmethoden vergleichbares onkologisches Ergebnis erwarten [14,15].…”