SURGICAL-MANAGEMENT OF PROSTATE-CANCER - CONTEMPORARY RESULTS WITH ANATOMIC RADICAL PROSTATECTOMY

In men with clinically localized prostate cancer whose life expectancy exceeds 10 years, radical prostatectomy has been considered the preferred treatment. When the cancer is confined to the prostate, radical prostatectomy has yielded excellent long term, cancer-free survival results; however, when the cancer escapes from the prostate, recurrence rates increase progressively with the degree of cancer spread. The morbidity and mortality rates for prostate cancer are high because, in the past, the cancer usually was detected late. Recent advances in early detection and surgical technique have increased the opportunities to improve treatment outcomes. However, some authors have questioned the preference of radical prostatectomy over expectant management. This article presents the author's experience with anatomic radical prostatectomy, in which an undetectable postoperative serum prostate specific antigen (PSA) level was used to measure the success of therapy in approximately 1000 patients treated during the past decade. The results are compared with those reported from other centers that also have ample experience with this operation. Together, these results suggest that contemporary anatomic radical prostatectomy provides unexcelled cancer control with low mortality and morbidity rates. With PSA screening, it is now possible to detect prostate cancers sooner, when patients are younger and more of the tumors are organ confined. Therefore, the treatment outcomes should be correspondingly more favorable in the future. Prospective, randomized studies are underway to compare the results of radical prostatectomy with those of expectant management in patients with clinically localized disease. However, until other treatments are proved to be as effective as radical prostatectomy in a representative patient population, radical prostatectomy should be considered the preferred treatment for men with localized prostate cancer whose life expectancy exceeds 10 years.