Radical Prostatectomy for the Treatment of Localized Prostatic Cancer

  • Patrick C. Walsh
  • Joseph E. Oesterling
  • Herbert Lepor

Abstract

The indications for radical prostatectomy must reflect: an understanding of the natural history of the disease, the projected life span of the patient, the stage of the disease, and the relative morbidity and efficacy of alternative therapeutic regimens. The integration of clinical stage, histologic grade, and pelvic lymph node evaluation has improved the selection of the ideal candidate for radical prostatectomy. In men with localized disease, there is no evidence that any treatment other than radical prostatectomy produces better control of the primary lesion and of distant metastases than does total surgical excision of the prostate. Recently the morbidity of radical prostatectomy has been reduced by improvements in surgical technique. Intraoperative identification and preservation of the branches of the pelvic plexus that innervate the corpora cavernosa has resulted in long-term postoperative potency rates of 72 percent without compromising complete excision of the tumor. Thus it appears possible today to preserve sexual function in a majority of patients undergoing radical prostatectomy without compromising the cancer operation, an observation that should encourage more physicians to take greater interest in diagnosing prostatic cancer at a stage when it is still curable.

Keywords

Placebo Adenocarcinoma Iodine Oncol Rosen 

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References

  1. 1.
    Cantrell, B.B., DeKlerk, D.P., Eggleston, J.C., Boitnott, J.K. and Walsh, P.C. Pathological factors that influence prognosis in Stage A prostatic cancer: the influence of extent versus grade. J. Urol. 125:516–520, 1981.PubMedGoogle Scholar
  2. 2.
    Epstein, J.I., Eggleston, J.C., Paull, G. and Walsh, P.C. Prognosis of untreated Stage Al prostate carcinoma: A study of 94 cases with extended follow-up. J. Urol. 136:837–839, 1986.PubMedGoogle Scholar
  3. 3.
    McMillen, S.M. and Wettlaufer, J.N. The role of repeat transurethral biopsy in Stage A carcinoma of the prostate. J. Urol. 116:759–760, 1976.PubMedGoogle Scholar
  4. 4.
    Carroll, P.R., Leitner, T.C., Yen, T.S.B., Watson, R.A., Williams, R.D. Incidental carcinoma of the prostate: significance of staging transurethral resection. J. Urol. 133:811–814, 1985.PubMedGoogle Scholar
  5. 5.
    Walsh, P.C. and Jewett, H.J. Radical surgery for prostatic cancer. Cancer 45:1906–1911, 1980.PubMedGoogle Scholar
  6. 6.
    Walsh, P.C. Radical prostatectomy with preservation of sexual function: evolution of a surgical prostatectomy. AUA Update Series 1986. Vol. 5. Lesson 5.Google Scholar
  7. 7.
    Eggleston, J.C. and Walsh, P.C. Radical prostatectomy with preservation of sexual function: Pathological findings in the first 100 cases. J. Urol. 134:1146–1148, 1985.PubMedGoogle Scholar
  8. 8.
    Catalona, W.J. and Dresner, S.M. Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. J. Urol. 134:1149–1151, 1985.PubMedGoogle Scholar
  9. 9.
    Pontes, J.E., Wajman, Z., Huben, R.P., Wolf, R.M. and Englander, L.S.: Prognostic factors in localized prostatic carcinoma. J. Urol. 134:1137–1139, 1985.PubMedGoogle Scholar
  10. 10.
    Elder, J.S., Gibbons, R.P., Correa, R.J.Jr. and Brannen, G.E. Efficacy of radical prostatectomy for Stage A2 carcinoma of the prostate. Cancer 56:2151–2154, 1985.PubMedCrossRefGoogle Scholar
  11. 11.
    Fowler, J.E. and Mills, S.E. Operable prostatic carcinoma: Correlations among clinical stage, pathological stage, Gleason histological score and early disease-free interval. J. Urol. 133:49–52, 1985.PubMedGoogle Scholar
  12. 12.
    Parfitt, H.E., Jr., Smith, J.A. Jr., Seaman, J.P. and Middleton, R.G. Surgical treatment of Stage A2 prostatic carcinoma: Significance of tumor trade and extent. J. Urol. 129:763–765, 1983.PubMedGoogle Scholar
  13. 13.
    Lange, P.H. and Narayan, P. Understaging and undergrading of prostate cancer. Urology 21:113–118, 1983.PubMedCrossRefGoogle Scholar
  14. 14.
    Elder, J.S., Jewett, H.J. and Walsh, P.C. Radical perineal prostatectomy for clinical Stage B2 carcinoma of the prostate. J. Urol. 127:704–706, 1982.PubMedGoogle Scholar
  15. 15.
    Bass, R.B., Jr. and Barrett, D.M. Radical retropubic prostatectomy after transurethral prostatic resection. J. Urol 124:495–497, 1980.PubMedGoogle Scholar
  16. 16.
    Nichols, R.T., Barry, J.M. and Hodges, C.V. The morbidity of radical prostatectomy for multifocal Stage I prostatic adenocarcinoma. J. Urol. 117:83–84, 1977.PubMedGoogle Scholar
  17. 17.
    Walsh, P.C. and Mostwin, J.L. Radical prostatectomy and cystoprostatectomy with preservation of potency: Results utilizing a new nerve-sparing technique. Br. J. Urol. 56:694–697, 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Leibel, S.A., Hanks, G.E. and Kramer, S. Patterns of care outcome studies: Results of the national practice in adenocarcinoma of the prostate. Int. J. Radiat. Oncol. Biol. Phys. 10:401–409, 1984.PubMedCrossRefGoogle Scholar
  19. 19.
    Schellhammer, P.F. and El-Mahdi, A.M. Pelvic complications after definitive treatment of prostate cancer by interstitial or external beam radiation. Urology 21:451–457, 1983.PubMedCrossRefGoogle Scholar
  20. 20.
    Jewett, H.J.: The case for radical perineal prostatectomy. J. Urol. 103:195–199, 1970.PubMedGoogle Scholar
  21. 21.
    Jewett, H.J. The results of radical perineal prostatectomy. JAMA 210:324–325, 1969.PubMedCrossRefGoogle Scholar
  22. 22.
    Oesterling, J.E., Brendler, C.B., Epstein, J.I., Kimball, A.W., and Walsh P.C. Correlation of the clinical stage, serum prostatic acid phosphatase, and preoperative Gleason grade with final pathologic stage in 275 patients with clinically localized adenocarcinoma of the prostate. J. Urol. 138:92- 98, 1987.Google Scholar
  23. 23.
    Diamond, D.A., Berry, S.J., Jewett, H.J., Eggleston, J.C. and Coffey, D.S. A new method to assess metastatic potential of human prostatic cancer; relative nuclear roundess. J. Urol 128:729–734, 1982.PubMedGoogle Scholar
  24. 24.
    Benson, M.C. and Walsh, P.C. The application of flow cytometry to the assessment of tumor cell heterogeneity and the grading of human prostate cancer. J. Urol. 135:1194–1198, 1986.PubMedGoogle Scholar
  25. 25.
    Schroeder, F.H. and Belt, E. Carcinoma of the prostate: A study of 213 patients with Stage C tumors treated by total perineal prostatectomy. J. Urol. 114:257–260, 1975.PubMedGoogle Scholar
  26. 26.
    Tomlinson, R.L., Currie, D.P. and Boyce, W.H. Radical prostatectomy. Palliation for Stage C carcinoma of the prostate. J. Urol. 117:85–87, 1977.PubMedGoogle Scholar
  27. 27.
    Boxer, R.J., Kaufman, J.J. and Goodwin, W.E. Radical prostatecotmy for carcinoma of the prostate: 1951–1976. A review of 329 patients. J. Urol. 117:208–213, 1977.PubMedGoogle Scholar
  28. 28.
    Zincke, H., Utz, D.C., Benson, R.C., Jr. and Patterson, D.E. Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for Stage C adenocarcinoma of prostate. Urology 24:532–539, 1984.PubMedCrossRefGoogle Scholar
  29. 29.
    Kuchler, H. Uber prostataver-Grosserungen. Deutsch. Klin 18:- 458, 1866.Google Scholar
  30. 30.
    Young, H.H. The early diagnosis and radical cure of carcinoma of the prostate - Being a study of 40 cases and presentation of a radical operation which was carried out in four cases. Johns Hopkins Hosp. Bull. 16:315–321, 1905..Google Scholar
  31. 31.
    Belt, E.: Radical perineal prostatectomy in early carcinoma of the prostate. J. Urol. 48:287–297, 1942.Google Scholar
  32. 32.
    Hodges, C.V. Vesicourethral anastamosis after radical prostatectomy: experience with the Jewett modification. J. Urol. 118:209–210, 1977.PubMedGoogle Scholar
  33. 33.
    Jewett, H.C. The present status of radical prostatectomy for Stages A and B prostatic cancer. Urol. Clin. North Am. 2:105–124, 1975.PubMedGoogle Scholar
  34. 34.
    Walsh, P.C., Lepor, H., Eggleston, J.C. Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations. The Prostate 4:473–485, 1983.PubMedCrossRefGoogle Scholar
  35. 35.
    Epstein, J.I., Walsh, P.C. and Eggleston, J.C. Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphanectomy specimens. J. Urol. 136:1234–1237, 1986.PubMedGoogle Scholar
  36. 36.
    Reiner, W.G. and Walsh, P.C. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery. J. Urol. 121:198–200, 1979.PubMedGoogle Scholar
  37. 37.
    Peters, C.A. and Walsh, P.C. Blood transfusion and anesthetic practices in radical retropubic prostatectomy. J. Urol 134:81–83, 1985.PubMedGoogle Scholar
  38. 38.
    Berlin, B.B., Cornwell, P.M., Connelly, R.R. and Eisenberg, H. Radical perineal prostatectomy for carcinoma of the prostate: survival in 143 cases treated from 1935 to 1958. J. Urol. 99:97–101, 1968.PubMedGoogle Scholar
  39. 39.
    Dees, J.E. Radical perineal prostatectomy for carcinoma. J. Urol. 104:160–162, 1970.PubMedGoogle Scholar
  40. 40.
    Belt, E. and Schroeder, F.H. Total perineal prostatectomy for carcinoma of the prostate. J. Urol. 107:91–96, 1972.PubMedGoogle Scholar
  41. 41.
    Davis, W.H., Scardino, P.L., Carlton, F.E. Radical prostatectomy. A 20-year overview. J. Urol. 108:604–608, 1972.PubMedGoogle Scholar
  42. 42.
    Williams, J., Marshall, V.F. and Gray, G.F. Jr Radical perineal prostatectomy with bilateral orchiectomy for carcinoma of the prostate. J. Urol. 113:380–384, 1975.Google Scholar
  43. 43.
    Veenema, R.J., Gursel, E.O. and Lattimer, J.K. Radical retropubic prostatectomy for cancer: A 20-year experience. J. Urol. 117:330–331, 1977.PubMedGoogle Scholar
  44. 44.
    Gibbons, R.P., Correa, R.J., Brannen, G.E. and Mason, J.T. Total prostatectomy for localized prostatic cancer. J. Urol. 131:73–76, 1984.PubMedGoogle Scholar
  45. 45.
    Kopecky, A., Laskowski, T.Z. and Scott, R. Jr. Radical retropubic prostatectomy in the treatment of prostatic carcinoma. J. Urol. 103:641–644, 1970.PubMedGoogle Scholar
  46. 46.
    Middleton, A.W., Jr. A comparison of the morbidity associated with radical retropubic prostatectomy with and without pubectomy. J. Urol. 117:202–205, 1977.PubMedGoogle Scholar
  47. 47.
    Crawford, E.D. and Kiker, J.D. Radical retropubic prostatectomy. J. Urol. 129:1145–1148, 1983.PubMedGoogle Scholar
  48. 48.
    Lieskovsky, G. and Skinner, D.G. Technique of radical retropubic prostatectomy with limited pelvic node dissection. Urol. Clin. North Am. 10:187–198, 1983.PubMedGoogle Scholar
  49. 49.
    McDuffie, R.W. Jr. and Blundon, K.E. Radical retropubic prostatectomy: 59 Cases. J. Urol. 119:514–516, 1978.PubMedGoogle Scholar
  50. 50.
    Gill, W.B., Marks, J.E., Straus, F.H., Sylora, H.O. and Diamond, H.M. Radical retropubic prostatectomy and retroperitoneal lymphadenectomy following radiotherapy conversion of Stage C to Stage B carcinoma of the prostate. J. Urol. 111:656–661, 1974.PubMedGoogle Scholar
  51. 51.
    Ray, G.R., Bagshaw, M.A. and Freiha, F. External beam radiation salvage for residual or recurrent local tumor following radical prostatectomy. J. Urol. 132:926–929, 1984.PubMedGoogle Scholar
  52. 52.
    Gibbons, R.P., Cole, B.S., Richardson, R.G., Correa, R.J., Jr., Brannen, G.E., Mason, J.T., Taylor, W.J. and Hafermann, M.D. Adjuvant radiotherapy following radical prostatectomy: Results and complications. J. Urol. 135:65–68, 1986.PubMedGoogle Scholar
  53. 53.
    Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. New Engl. J. Med. 312:1465–1472, 1985.Google Scholar
  54. 54.
    Ray, G.R., Bagshaw, M.A., Freiha, F. External beam radiation salvage for residual or recurrent local tumor following radical prostatectomy. J. Urol. 132:926–930, 1984.PubMedGoogle Scholar
  55. 55.
    Oesterling, J.E., Epstein, J.I. and Walsh, P.C. Long-term autopsy findings following radical prostatectomy. Urology 29:584–588, 1987.PubMedCrossRefGoogle Scholar
  56. 56.
    Walsh, P.C. and Epstein, J.I. Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J. Urol. 138:823–827, 1987.PubMedGoogle Scholar
  57. 57.
    Byar, D.P., Corle, D.K.and Veterans Administration Cooperative Urological Research Group. VACURG randomized trial of radical prostatectomy for Stages I and II prostate cancer. Urology Suppl. 17:7–11, 1981.Google Scholar
  58. 58.
    Madsen, P.O., Maigaard, S., Corle, D.K. and Byar, D.P. Radical prostatectomy for carcinoma of the prostate, Stage I and II. New results of the Veterans Administration Cooperative Urological Research Group, in: “Proceedings of International Symposium on the Treatment of Carcinoma of the Prostate”, A. Rost and U. Fiedler eds., Urologischte Klinik, Klinikum Steglitz, Freie Universität, Berlin, 1980.Google Scholar
  59. 59.
    Walsh, P.C. Randomized study of prostate cancer. Urology 18:219, 1981.PubMedCrossRefGoogle Scholar
  60. 60.
    Byar, D.P. and Corle, D.K. Randomized study of prostatic cancer. Urology 18:219–220, 1981.CrossRefGoogle Scholar
  61. 61.
    Bagshaw, M.A. Potential for radiotherapy alone in prostatic cancer. Cancer 55:2079–2085, 1985.PubMedCrossRefGoogle Scholar
  62. 62.
    Scardino, P.T., Frankel, J.M., Wheeler, T.M., Meacham, R.B., Hoffman, G.S., Seale, C., Wilbanks, J.H., Easley, J., and Carlton, C.E., Jr. The prognostic significance of post-irradiation biopsy results in patients with prostatic cancer. J. Urol. 135:510, 1986.PubMedGoogle Scholar
  63. 63.
    Freiha, F.S. and Bagshaw, M.A. Carcinoma of the prostate: Results of post-irradiation biopsy. The Prostate 5:19–25, 1984.PubMedCrossRefGoogle Scholar
  64. 64.
    Schellhammer, P.F., Ladaga, L.E. and El-Mahdi, A. Histological characteristics of prostatic biopsies after iodine implantation. J. Urol. 123:700–705, 1980.PubMedGoogle Scholar
  65. 65.
    Paulson, D.F., Lin, G.H., Hinshaw, W. and Stephani, S. The Uro-Oncology Research Group. J. Urol. 128:502–505, 1982.PubMedGoogle Scholar
  66. 66.
    Paulson, D.F. Personal communication.Google Scholar
  67. 67.
    Bagshaw, M.A. Radiotherapy of prostatic cancer: Stanford University Experience, in: “Progress and Controversies in Urological Oncology.” K.H. Kurth, F.M.J. Debruyne, F.H. Schroeder, T.A.W. Splinter and T.D.J. Wagener, eds., Alan R. Liss, New York, 1984.Google Scholar
  68. 68.
    Rosen, E., Cassady, J.R., Connolly, J. and Chaffey, J.T. Radiotherapy for prostate carcinoma: The JCRT experience (1968–1978) II. Factors related to tumor control and complications. Int. J. Radiat. Oncol. Biol. Phys. 11:725–730, 1985.CrossRefGoogle Scholar
  69. 69.
    Goldstein, I., Feldman, M.I., Deckers, P.J., Babayan, R.K. and Krane, R.J. Radiation-associated impotence. JAMA 251:903–910, 1984.PubMedCrossRefGoogle Scholar
  70. 70.
    Jordan, G.H., Lynch, D.F., Warden, S.S., McGraw, J.D., Hoffman, G.C. and Schellhammer, P.F. Major rectal complications following interstitial implantation of Iodine for carcinoma of the prostate. J. Urol. 134:1212–1214, 1985.PubMedGoogle Scholar
  71. 71.
    Schellhammer, P.F., El-Mahdi, A.E., Ladaga, L.E. and Schultheiss, T. 125 Iodine implantation for carcinoma of the prostate:5-year survival free of disease and incidence of local failure. J. Urol. 134:1140–1145, 1985.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1988

Authors and Affiliations

  • Patrick C. Walsh
    • 1
  • Joseph E. Oesterling
    • 1
  • Herbert Lepor
    • 1
  1. 1.Department of Urology, James Buchanan Brady Urological InstituteThe Johns Hopkins University and HospitalBaltimoreUSA

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