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CA: A Cancer Journal for Clinicians, Vol 49, Issue 5 282-296, Copyright © 1999 by American Cancer Society
W. J. Catalona, C. G. Ramos and G. F. Carvalhal
With current clinical practice, most newly diagnosed cases of prostate
cancer are potentially life-threatening yet still curable. The anatomical
(nerve-sparing) radical prostatectomy has dramatically improved the results
of surgical treatment. Other new management options, including conformal
(three-dimensional) external beam radiation therapy, radioactive seed
implantation (brachytherapy), cryoablation, and hormonal therapy, may be
useful in some patients, but they are all probably less effective than
radical prostatectomy. Suitability for radical prostatectomy generally
requires a clinically localized, potentially life-threatening tumor [as
defined by Gleason grade, tumor stage, and serum prostate-specific antigen
(PSA) level], a life expectancy of 10 years, and no serious co-morbid
medical conditions. With contemporary radical prostatectomy, about 70% of
men with clinically localized disease will be cured, depending on tumor
grade, tumor stage, and the serum PSA level. Urinary continence and sexual
potency can be preserved in most patients, but substantially better results
have been reported from centers of excellence than from community-based
series. Other complications occur in about 10% of patients and with greater
frequency in older patients. The operative mortality rate is less than
0.5%. Neoadjuvant hormonal therapy does not appear to affect treatment
failure rates in patients undergoing radical prostatectomy. Prostatectomy
may be beneficial in patients with microscopic lymph node metastases.
Postoperative adjuvant radiotherapy may also be beneficial for patients
with adverse pathologic findings. Salvage radical prostatectomy after
radiation failure is associated with a 10-fold higher risk of complications
and limited prospects for cure. Prospective, randomized clinical trials are
underway to compare the results of radical prostatectomy with other
treatments. Currently, radical prostatectomy is considered the preferred
treatment for men with localized disease and a 10-year life expectancy.
ARTICLES
Contemporary results of anatomic radical prostatectomy
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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