OncologyComplications of Open Radical Retropubic Prostatectomy in Potential Candidates for Active Monitoring
Section snippets
Material and Methods
From 1983 to 2006, 4265 men underwent RP by a single surgeon (WJC). Unilateral or bilateral nerve-sparing surgery (NSS) was performed in most cases with no intraoperative evidence of extraprostatic tumor extension.
Clinical information was collected in a prospective database. This study had institutional review board approval, and all participants provided informed consent. From this surgical population, we identified men who met one of three criteria for AM derived from the literature:
Results
Table 1 shows the demographics of the study population, which included 298 (7%) men in the thirties and forties, 1496 (35%) in their fifties, 1934 (45%) in their sixties, and 536 (13%) aged 70 or more years. In our RP database, 3458 men would have met the Patel AM criteria. The mean preoperative PSA was 7.1 ng/mL and the mean age was 61. The majority were white, had a Gleason score of 6 or less, and clinical stage T1c or T2 disease treated with bilateral NSS. At a mean follow-up of 60 months,
Discussion
Considerable controversy exists over the appropriate management of men with low-risk PCa. Striking an optimal balance between cancer control and quality of life (QOL) is especially important in this population. Treatment-related morbidity would be more acceptable in patients with a greater risk of cancer progression in the absence of definitive therapy.
Several prior studies have compared the differences in QOL between men with early stage PCa undergoing various different types of management.
Conclusions
There is ongoing debate about the preferred management of low-risk PCa patients in attempting to balance the often-competing goals of cancer control and preserving QOL. Our study shows that RP performed by a high-volume surgeon is generally associated with a low risk of complications and favorable long-term functional outcomes in men considered appropriate candidates for active monitoring. Young men have the lowest risk of treatment-related morbidity and may have the most to gain from curative
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Cited by (33)
Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL)
2017, Journal of the Chinese Medical AssociationCitation Excerpt :Bill-Axelson et al. have shown the survival advantage of radical prostatectomy over watchful waiting for male patients younger than 65 years old.29 The younger PCa patients also have lower treatment-related morbidities such as incontinence and erectile dysfunction.30 Previous reports have also shown a better biochemical progression-free survival after prostatectomy, and less advanced disease at prostatectomy for younger males.31,32
Baseline prostate-specific antigen testing at a young age
2012, European UrologyCitation Excerpt :In addition, there is evidence from randomized trials demonstrating a survival advantage of radical prostatectomy over watchful waiting for men <65 yr of age [47]. Treatment-related morbidity is also significantly lower in younger men, including lower rates of incontinence and erectile dysfunction [48]. These combined findings suggest that active treatment may be more effective, with less associated side effects, in younger men.
Safety profile of robot-assisted radical prostatectomy: A standardized report of complications in 3317 patients
2011, European UrologyCitation Excerpt :Many authors have reported on the rate of complications following open radical prostatectomy (ORP) [1,2], laparoscopic radical prostatectomy (LRP) [3–5], or robot-assisted radical prostatectomy (RARP) [6,7].
Survival analysis in men undergoing radical prostatectomy at an age of 70 years or older
2010, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Since the aggressiveness of prostate cancer does not diminish with increasing age [3], elderly men with a long life expectancy remain at risk of dying of the disease if managed conservatively. Considering the high prevalence of the disease [4], the impaired functional outcome [5] and the uncertain survival advantage after radical prostatectomy in elderly men [2], improving the estimation of further life expectancy is of paramount clinical concern in this population. Nevertheless, little data are available on long-term survival and the prognostic role of comorbidity classifications in men selected for radical prostatectomy at age 70 years or older.
This study was supported in part by the Urological Research Foundation and Beckman Coulter, Inc., Fullerton, California.