Radical Prostatectomy in the Management of Clinically Localized Prostate Cancer

Raviender Bukkapatnam, MD, and Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2001;8(6) 

In This Article

Abstract and Introduction

Background: Several management options are available when prostate cancer is diagnosed at an early stage. However, the optimal treatment for localized prostate cancer is unknown, and reports in the literature are controversial regarding the best treatment modality for this early presentation.
Methods: The authors review improvements in surgical technique that have decreased complications, and they address long-term outcomes of surgery related to cancer control.
Results: Improvements in surgical techniques allow for decreased intraoperative complications. The incidence of long-term complications such as incontinence and impotency is also reduced. The 5- and 10-year progression-free survival with radical prostatectomy has improved.
Conclusions: Surgery today is safer with improvements in techniques. The long-term outcomes with surgery are excellent and, in several series, better than outcomes achieved with other treatment modalities.

Only a decade ago, men diagnosed with prostate cancer presented with advanced disease that was beyond cure. Today, the majority of patients present with clinically localized disease at the time of diagnosis. Contributing factors include the widespread use of the prostate-specific antigen (PSA) and the availability of transrectal ultrasound to aid in biopsy of the prostate when evaluating an abnormal PSA or digital rectal examination or both. Several management options are available when prostate cancer is diagnosed at an early stage. These options include surgery, radiation therapy (external-beam, brachytherapy, or a combination of both), cryosurgery, or observation. The optimal treatment for localized prostate cancer is unknown, and reports in the literature are controversial regarding the best treatment modality for this early presentation. [1]

Any local treatment modality has the potential for complications that might impair the patient's quality of life. Surgery presents several possible intraoperative complications such as bleeding that requires transfusion, and postoperative complications such as incontinence, erectile dysfunction, or stricture formation may occur.

This review addresses the most significant improvements in surgical technique that have dramatically decreased these complications. The long-term outcomes of surgery related to cancer control are also addressed.

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