2010, Number 4
Surgical and oncological results of radical prostatectomy: experience of 7 years at the Hospital General de Occidente
Ruíz-Delgado J, Rincón-Gallardo Conde S, Camarena-González L, Jáuregui-Mendoza E, Rodríguez-Farías J, Cueva-Martínez A, Ochoa-De La Peña A, Rivas-Gómez R, Rodríguez-Rivera A
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Language: Spanish
References: 26
Page: 219-223
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ABSTRACT
Background: Prostate cancer is the principal cancer diagnosis in men and the second cause of death by cancer in men in the United States. It is in 4th place worldwide in frequency but corresponds to only 9% of all cancer-specific deaths in men. Radical prostatectomy is the most widely used therapy for the treatment of organconfined disease and in select cases of nodular disease or its possibility. It is considered to be the criterion standard in relation to other alternatives such as radiotherapy, brachytherapy, high-intensity focused ultrasound, and watchful waiting.Objective: To demonstrate the experience in the authors’ hospital department in prostate cancer treatment and to report the similarity of results with published standards in relation to surgical outcome and oncological disease follow-up.
Results: A total of 80 patients that underwent radical prostate surgery were evaluated. Mean age was 61.5years (46-74 year range), mean surgery duration was 250 minutes, patients requiring transfusion was 40%, patients requiring 1 transfusion bag was 80%, 2 transfusion bags 20%, mean hospital stay was 72 hours, intraoperative hemorrhage was 280-1500 cc, deep vein thrombosis incidence was 3%, pulmonary thromboembolism was 1.25% and there was 1 death. The most prevalent preoperative or diagnostic prostate specific antigen was 6.2 ng/mL. Transrectal biopsy of the prostate Gleason score was 3+3, positive lymph node suspicion was 7.5% in patients according to Partin, predominant Gleason score in surgical specimen was 3+2, and 5% of specimens had positive margins. There was correlation between transrectal biopsy of the prostate and final specimen Gleason scores in only 27% of cases. Postoperative prostate specific antigen was underestimated in 31% of patients and overestimated in 42%. In the first year 92% of patients had postoperative prostate specific antigen under 0.4 ng/mL and 8% did not reach that nadir. During the first year 92% of patients continued to have prostate specific antigen values under the nadir and 8% had biochemical recurrence. The second year the change was slight in which prostate specific antigen value in 90% of patients did not go above the nadir and 10% continued in biochemical failure but under 1.5 ng/mL. In the third year of follow-up, prostate specific antigen of 90% of patients continued under the nadir but of the 10% in biochemical failure, two patients had prostate specific antigen above 1.5 ng/mL and bone metastases was seen with scintigram in one patient. In the fourth year of follow-up 80% of patients had prostate specific antigen values under 0.4 ng/mL and 20% were over that figure. At five years, 75% of patients had unchanged prostate specific antigen, 25% reached biochemical failure, but only 2 patients continued to have prostate specific antigen above 1.5 ng/mL. The death of one of those patients was related specifically to prostate cancer.
Conclusions: Radical prostate surgery at the authors’ hospital is the most widely used treatment for organconfined disease. Reproducibility and perfection of this technique have resulted in tangible improvements in surgical results (shorter hospital stay, intraoperative and perioperative complication reduction, improved vascular control and thus lower blood transfusion rate and a reduction in intraoperative hemorrhage) as well as in oncological results that are reflected in better patient selection, positive margin reduction, and early identification of high risk patients for metastatic progression or nodular disease.
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