ANTEROGRADE RADICAL RETROPUBIC PROSTATECTOMY FOR CURE CLINICALLY LOCALISED PROSTATE CANCER: ONCOLOGICAL OUTCOME IN 17-YEAR SERIES

INTRODUCTION & OBJECTIVES: Nowadays, it is estimated that RP is performed in approximately 45% of all patients with a newly diagnosed prostate cancer. The most frequently performed operation is open retropubic approach as described by Walsh and coworkers in the early 80's. The objective of this study is to analyze the oncological outcome of more than 800 patients treated using a modified technique of anterograde open radical prostatectomy over a 17 years period. MATERIAL & METHODS: We retrospectively reviewed the clinical and pathological data of 845 patients who underwent radical prostatectomy for clinically localised prostate cancer between 1988 and 2004 (in 803 of these with concomitant pelvic linfadenectomy). The entire prostate was examined, all specimens were restaged according to the 1997 American Joint Committee on Cancer (AJCC) staging system. The follow-up schedule included serum PSA assay every 3 months for the first year, then every 6 months for the following two years and yearly thereafter. Patients with pathologically involved lymph nodes received early adjuvant hormonal therapy. Kaplan Meier method and Cox proportional hazard model were used for statistical analysis. A total of 107 were excluded from the survival analysis. RESULTS: Overall, positive surgical margins were detected in 108 patients (12.7%), 71 (65.7%) without a concurrent lymph-nodes involvement, including 2.1% (7/326) with pathologically organ confined prostate cancer, and 16.3% (64/393) with extraprostatic disease. The mean (median, range) follow-up of the 753 patients included in the survival analysis was 46.2 (40.5, 6-168) months. The 5- and 8-year actuarial biochemical recurrence- free survival rate for nodes negative patients was 75.3% and 69.8%. The 122 patients with positive lymph nodes, treated with early adjuvant hormonal therapy, had a 5- and 8- year progression- free survival of 59.3% and 34.7%, respectively. Tumour stage, Gleason score, preoperative PSA and surgical margins status were all significant independent predictors of biochemical-free survival at multivariate Cox model analysis. CONCLUSIONS: Anterograde radical retropubic prostatectomy provides a good cancer control and a low incidence of positive surgical margins even in presence of extracapsular tumour spread. These series represent the first reported on oncological outcome of anterograde open prostatectomy and should be considered when results of laparoscopic and open prostatectomy are compared.