Minor modifications in apical dissection of radical retropubic prostatectomy in patients with clinical stage T2 prostate cancer reduce positive surgical margin incidence

Urology ◽  
2004 ◽  
Vol 63 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Brett A. Laven ◽  
Nejd F. Alsikafi ◽  
Ximing J. Yang ◽  
Charles B. Brendler
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Surgical Margin ◽  
Radical Retropubic Prostatectomy ◽  
Positive Surgical Margin ◽  
Retropubic Prostatectomy

scholarly journals Contemporary Radical Prostatectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Qiang Fu ◽  
Judd W. Moul ◽  
Leon Sun
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Radical Retropubic Prostatectomy ◽  
Pelvic Surgery ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Retropubic Prostatectomy ◽  
Significant Difference ◽  
Perineal Prostatectomy

Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy.Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed.Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer.Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

Role of Bilateral Pelvic Lymphadenectomy in Prostatic Cancer

1997 ◽  
Vol 64 (3) ◽  
pp. 348-350
Author(s):  
A. Fandella ◽  
L. Maccatrozzo ◽  
F. Merlo ◽  
L. Faggiano ◽  
P. Cecchin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Lymph Node Involvement ◽  
Radical Retropubic Prostatectomy ◽  
Low Risk ◽  
Retropubic Prostatectomy ◽  
Node Involvement

Objectives: to identify a group of patients with prostate cancer for whom open staging pelvic lymph node dissection (PLND) could be superfluous. Methods: the medical records of all patients presenting with prostate cancer from January 1992 to December 1996 were reviewed. A total of 118 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Final nodal status was correlated with the value of the preoperative serum prostate specific antigen (PSA) concentration, clinical stage (TNM), and grading (by OMS) to evaluate the predictivity of nodal involvement. We identified 3 groups: PSA <10 ng/ml, T1–2, G1-2, = 1st very low risk, PSA 10 −15, T1-2 - G1-2 = 2nd low risk, PSA <15 T3 or G3 or PSA >15 every T and G = 3rd high risk. Results: overall, only 21 patients (18%) had lymph node metastases. Lymph node involvement was significantly correlated with elevated serum PSA values, high grading, and advanced clinical stage. 35 patients belonged to the first 2 groups, presenting with low PSA and favorable clinical stage and grade, none with lymph node involvement. These patients could have avoided PLND with a very low risk of missing something. Conclusions: open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.

NEOADJUVANT FOR PATIENTS WITH HIGH AND VERY HIGH RISK PROSTATE CANCER

2019 ◽  
Vol 65 (5) ◽  
pp. 726-735 ◽  
Author(s):  
A. Nosov ◽  
Sergey Reva ◽  
M. Berkut ◽  
Svetlana Protsenko ◽  
A. Arnautov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Group Treatment ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Chemohormonal Therapy ◽  
Very High

Objective: to assess safety, pathological response rate, and long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemotherapy using docetaxel in prostate cancer (PCa) patients of high and very high risk groups. Materials and methods: 86 patients with high and very high risk PCa (PSA>20 ng/ml, Gleason score 8 and more, or clinical stage cT2c and more) were included, among them 46 received neoadjuvant (NCGT/RP group) treatment followed by RP and 40 patients received RP only. with a median follow-up of 11.4 years after RP. Neoadjuvant treatment included 3-weekly docetaxel (75 mg/m2 for up to 6 cycles) with concomitant degarelix (6 monthly injections). Results: NCGT cycle was started in 39 patients and completed in full dose and planned regimen in 34 (87.2%) patients. Toxicities were moderate. A statistically significant reduction of PSA>50% post-chemohormonal therapy was observed in all 39 cases. Among patients with completed neoadjuvant treatment RP was performed in 33 (97.1%) patients. Lower postoperative stage was noticed in 38.5% in NCGT/RP group compared with 2.7% in RP group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy - 43.2% and 25.6% (RP group). Adjuvant or deferred treatment received 25 (67.6%) and 13 (39.4%) in RP and NCGT/RP group, respectively. Conclusion: The use of neoadjuvant chemohormonal therapy before the RP in selected regimen and dose represents a safe strategy resulting in benefit in early oncological results. Given the limitations of the study this concept should be evaluated in large prospective controlled studies.

Radical Retropubic Prostatectomy and Robotic-assisted Laparoscopic Prostatectomy: Likelihood of Positive Surgical Margin(s)

Urology ◽  
2010 ◽  
Vol 76 (5) ◽  
pp. 1097-1101 ◽  
Author(s):  
Stephen B. Williams ◽  
Ming-Hui Chen ◽  
Anthony V. D'Amico ◽  
Aaron C. Weinberg ◽  
Ravi Kacker ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Radical Retropubic Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Retropubic Prostatectomy

scholarly journals Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

2018 ◽  
Vol 04 (04) ◽  
pp. e226-e234 ◽  
Author(s):  
Stefanie Croghan ◽  
Deep Matanhelia ◽  
Ann Foran ◽  
David Galvin
Keyword(s):  
Specific Antigen ◽  
Surgical Margin ◽  
Radical Retropubic Prostatectomy ◽  
Disease Stage ◽  
Published Data ◽  
Positive Surgical Margin ◽  
Retropubic Prostatectomy ◽  
Oncological Outcomes ◽  
Irish Context

Objectives There is a little published data on the outcomes of radical prostatectomy in the Irish context. We aimed to determine the 5-year oncological results of open radical retropubic prostatectomy (RRP) performed by a single surgeon following appointment. Methods A retrospective review of RRPs performed between 2011 and 2016 was conducted. Patient demographics, preoperative parameters (clinical stage on digital rectal exam, prostate-specific antigen (PSA) levels, biopsy Gleason's score and MRI [magnetic resonance imaging] findings), pathological variables (T-stage, Gleason's score, nodal status, and surgical margin status), and treatment decisions (lymphadenectomy or adjuvant radiotherapy) were recorded. Oncological outcome at last follow-up was ascertained. Results 265 patients underwent RRP between 2011 and 2016. Median age was 62 years (range: 41–74). Mean follow-up was 32.24 months (range: 8–72) months. Pathological disease stage was T2 in 170/265 (64.15%), T3a in 65/265 (24.53%), and T3b in 30/265 (11.32%). Final Gleason's score was upgraded from diagnostic biopsy in 16.35% (43/263) and downgraded in 27% (71/263). Pelvic lymph node dissection was performed in 44.25% (118/265) patients. A positive surgical margin (PSM) was seen in 26/170 (15.2%) patients with T2 disease and in 45/95 (47.37%) patients with T3 disease. Of the 265 patients, 238 (89.81%) were disease-free at last follow-up, of whom 24/238 (10.08%) had received adjuvant and 17/238 (7.14%) received salvage radiotherapy. Adjuvant/salvage treatment was ongoing in 19/265 (7.17%) of patients. Conclusion Good oncological outcomes of RRP in the Irish context are seen in this 5-year review, with the vast majority of patients experiencing biochemical-free survival at most recent follow-up.

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