Total Prostatectomy for Localized Prostatic Cancer

Abstract

Several treatment options currently are available for the patient with clinically localized carcinoma of the prostate and each has its proponents. Comparison of results between institutions becomes necessary to determine the relative value of these treatments, keeping in mind the absence of a suitable control group in any series. Such inter-institutional treatment comparisons are possible only if the patient compositions are similar in terms of age, grade and extent of disease. Comparisons of patients with stage B disease frequently are made because most urologists agree that these patients have palpable disease confined to the prostate and no evidence of metastasis. At our clinic willing patients with clinically localized adenocarcinoma of the prostate who have an expected 15-year survival are treated preferentially with total prostatectomy. We summarize our experience with total prostatectomy in 215 consecutive patients, including 213 who were available for followup. There were 16 patients with clinical stage A, 195 with clinical stage B and 2 with clinical stage C disease. Of these patients 207 underwent radical perineal prostatectomy and there were no operative deaths. Patients did not receive adjuvant hormonal therapy unless disease recurred. Of the 110 patients who have undergone the operation within the last 5 years 98 per cent are alive. Actual survival and survival free of disease, respectively, for the entire series were 55 and 48 per cent at 15 years, 75 and 67 per cent at 10 years, and 94 and 86 per cent at 5 years, compared to 55 and 48, 74 and 67, and 95 and 90 per cent, respectively, for the 195 patients with clinical stage B disease. We believe these results demonstrate that in terms of local control of the disease, over-all survival and survival free of disease total prostatectomy remains the optimal treatment for patients with clinically localized carcinoma of the prostate.

Primary Radiation Therapy in the Treatment of Localized Prostatic Cancer

“…Similar results have been reported following radical surgery (31). Therefore the early stage prostatic cancer, which has been radically treated, does not essentially increase the risk of death.…”

Changes of Urodynamic Findings after Radical Retropubic Prostatectomy

“…The incidence of continence achieved in the present trial (97% of the total patient population without any instance of total incontinence) is in the range of the reported rates between 67 and 96%, with 0–35% of the patients demonstrating stress incontinence and 0–18% complaining of total incontinence in the literature [10, 12, 13, 14, 15, 16, 17, 18, 19]. The discrepancy between these rates might in part reflect differences in study design, patient population length and completeness of follow-up, methods for measuring incontinence, surgical proficiency and interviewers.…”

Quality of Life Aspects of Treatment Options for Localized and Locally Advanced Prostate Cancer

“…The major problems associated with radical prostatectomy are high rates of impotence and urinary incontinence, which can affect quality of life [12, 13]. However, Walsh [14]reported that with good nerve-sparing techniques, continence and potency rates should be high, resulting in excellent quality of life in patients with localized disease.…”