UroToday - Complications of Open Radical Retropubic Prostatectomy in Potential Candidates for Active Monitoring - Abstract

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Wednesday, 26 March 2008

Department of Urology, s Hopkins School of Medicine, Baltimore,

land.

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.

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.

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.

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.

Written by

Loeb S, Roehl KA, Helfand BT, Catalona WJ.

Reference

Urology. 2008 Mar 6. Epub ahead of print.

doi:10.1016/j.urology.2007.12.016

PubMed Abstract

PMID:18329080