MEDIUM TO LONG TERM OUTCOME OF PATIENTS TREATED WITH RADICAL RETROPUBIC PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER
Abstract
Objective:To evaluate the medium to long term cancer control, morbidity, mortality and functional outcome in men undergoing open radical retro pubic prostatectomy (RP) and pelvic lymph node dissection (PLND) for clinically localized adenocarcinoma prostate (CaP).Methods:A total of 200 patients were operated with intention to treat for localized CaP, between January 1998 to October 2013. Patients' characteristics, operative data, progression-free survival rate, recurrence rate, morbidity, mortality and functional outcome were analyzed. Statistical analysis was done using SPSS v.19. Kaplan Meir curve was plotted for survival estimate.Results:The mean age was 63.6 + 6.2 years and median pre-operative PSA was 11+ 2.1 ng/ml. RP and bilateral PLND were performed in 172 patients of which 35 (20%) had nerve-sparing surgery. In 8 cases with gross lymph node metastasis at frozen section, only bilateral orchiectomy was done while remaining 20 patients had RRP+PLND with bilateral orchiectomy. The final study population was therefore 192. Mean length of hospital stay was 6 + 1 day with zero 30-day perioperative mortality. On final histopathology, 78% of tumors were confined to the prostate gland. Twenty four (12.5%) patients had positive surgical margins. Overall, 163 (85%) patients regained full continence. Nearly half of patients with nerve sparing approach were potent without any supportive measures. Most common long term complication was urethral stricture (8%). At median follow up of 41 months, the progression-free and overall survival rates were 85% and 94%, respectively. Seven percent had biochemical recurrence while 4% had local recurrence and 4% had metastatic disease.Conclusions:
Our results indicate that RP has an excellent potential for cancer control and functional outcome with low morbidity in men with localized CaP. Our data is consistent with larger data from other centers around the world.
Background: To evaluate the medium to long term cancer control, morbidity, mortality and functional outcome in men undergoing open radical retro pubic prostatectomy (RP) and pelvic lymph node dissection (PLND) for clinically localized adenocarcinoma prostate (CaP). Methods: A total of 200 patients were operated with intention to treat for localized CaP, from January 1998 to October 2013. Patients' characteristics, operative data, progression-free survival rate, recurrence rate, morbidity, mortality and functional outcome were analysed. Statistical analysis was performed using SPSS v.19. Kaplan Meir curves were plotted for survival estimate. Results: The mean age was 63.6±6.2 years and median pre-operative PSA was 11±2.1 ng/ml. RP and bilateral PLND were performed in 172 patients of which 35 (20%) had nerve-sparing surgery. In 8 cases with gross lymph node metastasis at frozen section, only bilateral orchiectomy was done while remaining 20 patients had RRP+PLND with bilateral orchiectomy. The final study population was therefore 192. Mean length of hospital stay was 6±1 day with zero 30-day perioperative mortality. On final histopathology, 78% of tumours were confined to the prostate gland. Twenty four (12.5%) patients had positive surgical margins. Overall, 163 (85%) patients regained full continence. Nearly half of patients with nerve sparing approach were potent without any supportive measures. Most common long term complication was urethral stricture (8%). At median follow up of 41 months, the progression-free and overall survival rates were 85% and 94%, respectively. Seven percent had biochemical recurrence while 4% had local recurrence and 4% had metastatic disease. Conclusions: Our results indicate that RP has an excellent potential for cancer control with low morbidity and good functional outcome in men with localized CaP. Our data is consistent with larger series from other centres across the globe.Keywords: Prostate Cancer; Radical Prostatectomy; Long term outcome
References
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64(1):9-29.
Kupelian PA, Elshaikh M, Reddy CA, Zippe C, Klein EA. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 2002;20(16):3376-85.
D'Amico AV, Whittington R, Malkowicz SB, Cote K, Loffredo M, Schultz D, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2):281-6.
González-San Segundo C, Herranz-Amo F, Alvarez-González A, Cuesta-Ãlvaro P, Gómez-Espi M, Paños-Fagundo E, et al. Radical prostatectomy versus external-beam radiotherapy for localized prostate cancer: long-term effect on biochemical control-in search of the optimal treatment. Ann Surg Oncol 2011;18(10):2980-7.
Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol 2000;163(6):1802-7.
Sriprasad S, Feneley MR, Thompson PM. History of prostate cancer treatment. Surg Oncol 2009;18(3):185-91.
Williams S, Chiong E, Lojanapiwat B, Umbas R, Akaza H. Management of prostate cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013;14(12):e524-34.
Alemozaffar M, Sanda M, Yecies D, Mucci LA, Stampfer MJ, Kenfield SA. Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study. Eur Urol 2015;67(3):432-8.
Nazim SM, Abbas F, Islam M, Ahmad Z. Validation of Updated Partin's Table in Pakistani Patients undergoing Radical Prostatectomy for Prostate Cancer. J Cancer Sci Ther 2011.
Abbas F, Siddiqui K, Biyabani SR, Hasan SH, Talati J. Early Surgical Results with intent to treat by Radical Retropubic Prostatectomy for Clinically localized Prostate Cancer. J Pak Med Assoc 2002;52(5):200-5.
Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004;172(3):910-4.
Loeb S, Smith ND, Roehl KA, Catalona WJ. Intermediate-term potency, continence, and survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology 2007;69(6):1170-5.
Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH, et al. Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol 2010;183(6):2213-8.
Hubanks JM, Umbreit EC, Karnes RJ, Myers RP. Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition: a contemporary series. Eur Urol 2012;61(5):878-84.
Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 2008;179(5 Suppl):S47-51.
Ayyathurai R, Manoharan M, Nieder AM, Kava B, Soloway MS. Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients. BJU Int 2008;101(7):833-6.
Herrmann TR, Rabenalt R, Stolzenburg JU, Liatsikos EN, Imkamp F, Tezval H, et al. Oncological and functional results of open, robot-assisted and laparoscopic radical prostatectomy: does surgical approach and surgical experience matter? World J Urol 2007;25(2):149-60.
Lepor H, Kaci L. The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. J Urol 2004;171(3):1216-9.
Stitzenberg KB, Wong YN, Nielsen ME, Egleston BL, Uzzo RG. Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care. Cancer 2012;118(1):54-62.
Gardiner RA, Yaxley J, Coughlin G, Dunglison N, Occhipinti S, Younie S, et al. A randomised trial of robotic and open prostatectomy in men with localised prostate cancer. BMC Cancer 2012;12:189
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
