SELECTION CRITERIA FOR RADICAL PROSTATECTOMY IN RELATION TO LONG-TERM RESULTS

Between July 1969 and May 1991 radical prostatectomies were performed in 410 consecutive patients with prostate cancer at the Department of Urology, University of Wurzburg. The calculated survival rates for these 410 patients up to 15 years after surgery are very similar to the life expectancy of the normal male age-matched population. In 127 of the 410 cases radical prostatectomy was carried out more than 10 years ago, so that the data relating to these cases have been definitely observed, not merely statistically evaluated. In order to permit a comparison of our results with those reported in the literature, the TNM classification of 1979 was utilized in this study. This means that only tumors penetrating through the capsule of the prostate were classified as stage pT3. Those tumors that are only infiltrating the apex or the prostatic capsule, are classified as stage pT2. For patients with stage pT1pN0M0 and pT2pN0M0-tumors, 10-year survival rates (90.5% and 70% respectively) were recorded which are even slightly better than those of the normal male age-matched population. For patients with tumors extending through the capsule, the 10-year survival rate was found to be 60%. Forty percent ot these patients with stage pT3pN0M0 disease are alive tumor-free after more than 10 years and can thus be regarded as cured. When lymph node metastases were present (stage pT2-3pN1-2M0), some of the patients appeared to benefit from radical prostatectomy, since 4 out of 11 patients with this stage disease survived for more than 10 years. On the basis of these results, it is our opinion that radical prostatectomy is indicated in patients with stage T1-3pN0M0 carcinoma of the prostate, if a life expectancy of at least 10 years is anticipated. When lymph node metastases are found at pelvic lymphadenectomy (stage T1-3pN12M0), radical prostatectomy cannot generally be recommended at the present time. Prospective, controlled studies are needed in order to find out whether such patients would in fact benefit from radical prostatectomy.