Elsevier

Urology

Volume 72, Issue 4, October 2008, Pages 887-891
Urology

Oncology
Complications of Open Radical Retropubic Prostatectomy in Potential Candidates for Active Monitoring

https://doi.org/10.1016/j.urology.2007.12.016Get rights and content

Objectives

With the widespread use of prostate-specific antigen (PSA)-based screening, there is now concern about the overdiagnosis and overtreatment of men with low-risk prostate cancer (PCa). One of the most difficult aspects of PCa management is a balance of the often-competing goals of cancer control with functional outcomes and quality of life. To address this issue, we examined the potency, continence and overall complication rates associated with radical prostatectomy (RP), specifically in potential candidates for active monitoring.

Methods

From a large RP database, we compared potency, continence, and complication rates among men meeting one of the following active monitoring criteria from the literature: clinically localized, Gleason score of 7 or less, and no significant comorbidities; T1b-T2b NOMO, Gleason score of 7 or less, and PSA of 15 ng/mL or less; and T1c PCa.

Results

There were 3458, 3533, and 2338 men who met the above criteria, respectively. After 18 months of follow-up, potency was preserved in 70% to 74%. At least 93% of patients were continent, and the rate of surgical complications ranged from 5% to 7%. Increasing age was significantly associated with a greater risk of all complications.

Conclusions

Men with newly diagnosed low-risk PCa must carefully weigh the risks and benefits of treatment. In young men with low-risk PCa, RP was associated with a relatively low complication rate and good long-term functional outcomes. However, with increasing age, RP was associated with significantly higher complication rates. These results can be used to help guide management decisions for men with low-risk disease.

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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This study was supported in part by the Urological Research Foundation and Beckman Coulter, Inc., Fullerton, California.

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