Radical Prostatectomy in the Management of Localised Carcinoma of the Prostate

Abstract

During the years 1971 to 1983 24 patients underwent radical prostatectomy for localised carcinoma of the prostate. There was one post-operative death from a pulmonary embolism, but all other patients were available for follow-up. All tumours were confirmed on palpation to be clinically localised to the prostate. Patients with clinical stages T0, T1, and T2 were referred for radical surgery. Patients with incidental carcinoma (T0), with less than 10% of the total tissue involved with carcinoma, were not subjected to surgery, and were followed up by observation only. Two patients developed recurrence of tumour at 18 to 12 months, and 2 years. One patient died 1 year later from the disease; he had a pathological T3 tumour with microscopic extension into the seminal vesicles. All other patients are alive and tumour-free at follow-up and 20 of the 23 patients are fully continent.

Radical Prostatectomy in Cases of Prostatic Carcinoma: The Problem of Postoperative Urinary Incontinence (With 1 color plate)

“…Today the opinion that, in cases of locally limited and non-metastasized prostatic carcinoma (T1-T2, No, Mo, G 1-3) with a good general state and corresponding life expectancy, radical prostatovesiculectomy is the best treatment is shared throughout the world [1][2][3], The euphoria over radiotherapy of locally limited prostatic carcinoma in the seventies [4,5] has given way to oper ative therapy because of the latter's indisputably better results [6,7], The surgical technique should be given preference over the radiotherapeutic method due to the higher complication rate of the latter [8] and the result ing inferior quality of life [9], This is especially impor tant for young men because prognosis is poorer [10]. Also prostatic carcinoma, accidentally discovered upon transurethral resection, can be curatively treated with good results by means of subsequent radical prostatec tomy without any supplementary risks [11][12][13], The matter of postoperative urinary incontinence, however, preoperatively strains the indication for radical prosta tectomy and possibly the relation between doctor and patient postoperatively.…”

Radical Prostatectomy in Cases of Prostatic Carcinoma: The Problem concerning Erectile Impotence (With 1 color plate)

“…There is worldwide [1][2][3] agreement with our opinion that the best treatment for locally limited, not metasta sized prostatic carcinoma (T|_2, N0, M0, G 1-3) in the otherwise healthy patient with a corresponding life ex pectancy is radical prostatovesiculectomy. The euphory over radiotherapy of locally limited prostatic carcinoma in the 1970s [4,5] has subsided, and radiotherapy has had to give way to operative therapy because of the lat ter's superior results [6,7], Considering the higher com plication rate [8] and the post-therapeutic lower quality of life [9], a surgical approach should be preferred to radiotherapy, especially in young men because of their poorer prognosis [10], It is furthermore possible to treat prostatic carcinoma found unexpectedly at transurethral resection with radical prostatectomy.…”

Treatment Preferences of Urologists in Great Britain and Ireland in the Management of Prostate Cancer

“…When treatment is deferred, a substantial proportion of patients will require subsequent hormonal manipulation as a result of disease progression (Handley et al, 1988). The more aggressive policies include hormonal therapy (Veterans Administration Cooperative Urological Research Group, 1967;Byar, 1973), radiotherapy (Scardino, 1986) and radical prostatectomy (Smith and Kelly, 1984;Paulson et al, 1988;Gibbons et al, 1989). These policies are influenced by the age and general condition of the patient prior to initiating a radical therapy, and the potential aggressiveness of the tumour as determined by its histological grade.…”