The online version of this article (doi:10.1186/1477-7819-10-249) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interest.
EO designed the study, acquired data, controlled the quality of the procedure as either operator or assistant during surgery for all 90 cases, carried out analysis and interpretation of data, and drafted the manuscript. MY, YM, AI and KaS contributed to the acquisition of data and participated in the surgery as either operator or assistant during some surgeries. HK contributed to the acquisition of data. NT and AH participated in the study design, contributed to the acquisition of data, participated in the surgery as either operator or assistant during some surgeries, and helped to draft the manuscript. KeS made the pathological diagnoses. KF and YH participated in the study design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
Retropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer.
A total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naïve prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR).
The surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2).
RRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.
Heidenrich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F, European Association of Urology: EAU guidelines on prostate cancer. Part I: Screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011, 59: 61-71. 10.1016/j.eururo.2010.10.039. CrossRef
Scher D, Awindle PW, Scardino PT: National comprehensive cancer network guidelines for the management of prostate cancer. Urology. 2003, 61: 14-24. 10.1016/S0090-4295(02)02395-6. CrossRef
Kordan Y, Salem S, Chang SS, Clark PE, Cookson MS, Davis R, Herrell SD, Baumgartner R, Phillips S, Smith JA, Barocas DA: Impact of positive apical surgical margins on likelihood of biochemical recurrence after radical prostatectomy. J Urol. 2009, 182: 2695-2701. 10.1016/j.juro.2009.08.054. CrossRefPubMed
Fujimoto H: Wide resection of the prostate with neoadjuvant hormone therapy. In the proceeding of the 18th international symposium: Controversies in prostate cancer diagnosis and treatment. Pu YS, Fujimoto H, Kakizoe T, Myers R. Jpn J Clin Oncol. 2005, 35: 680-689. 10.1093/jjco/hyi180. CrossRefPubMed
Fujimoto H: Radical prostatectomy with neoadjuvant hormone therapy for cT3 prostate cancer. Nippon Rinsho. 2005, 63: 271-278. Article in Japanese PubMed
Epstein JL: Tumors of the prostate. Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs. International Agency for Research on Cancer. Edited by: John NE. 2004, Lyon: World Health Organization Classification of Tumours, 179-184.
Epstein JL: Tumors of the prostate. Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs. International Agency for Research on Cancer. Edited by: Ebele JN, Sauter G, Epstein JI, Sesterhenn IA. 2004, Lyon: World Health Organization Classification of Tumours, 61-ISBN 92 83 22415 9
Inagaki T, Kohjimoto Y, Nishizawa , Kuramoto T, Nanpo Y, Fujii R, Matsumura N, Shintani Y, Uekado Y, Hara I: PSA at postoperative three months can predict biochemical recurrence in patients with pathological T3 prostate cancer following radical prostatectomy. Int J Urol. 2009, 16: 941-946. 10.1111/j.1442-2042.2009.02401.x. CrossRefPubMed
Naito S, Kuroiwa K, Kinukawa N, Goto K, Koga H, Ogawa O, Murai M, Shiraishi T, Clinicopathological Research Group for Localized Prostate Cancer Investigators: Validation of Partin tables and development of a preoperative nomogram for Japanese patients With clinically localized prostate cancer using 2005 International Society of Urological Pathology Consensus on Gleason Grading: Data from the Clinicopathological Research Group for Localized Prostate Cancer. J Urol. 2008, 180: 904-910. 10.1016/j.juro.2008.05.047. CrossRefPubMed
Schiavina R, Bertaccini A, Franceschelli A, Manferrari F, Vagnoni V, Borghesi M, Morselli-Labate AM, Martorana G: The impact of the extent of lymph-node dissection on biochemical relapse after radical prostatectomy in node-negative patients. Anticancer Res. 2010, 30: 2297-2302. PubMed
Kupelian PA, Katcher J, Levin HS, Klein EA: Stage T1-2 prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Int J Radiation Oncology Biol. Phys. 1977, 37: 1043-1052. CrossRef
Kordon Y, Salem S, Chang SS, Clark PE, Cookson MS, Davis R, Herrell SD, Baumgartner R, Phillips S, Smith JA, Barocas DA: Impact of apical surgical margins on likelihood of biochemical recurrence after radical prostatectomy. J Urol. 2009, 182: 2695-2701. 10.1016/j.juro.2009.08.054. CrossRef
Eggener SE, Scardino PT, Walsh PC, Han M, Partin AW, Trock BJ, Feng Z, Wood DP, Eastham JA, Yossepowitch O, Rabah DM, Kattan MW, Yu C, Klein EA, Stephenson AJ: Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol. 2011, 185: 869-875. 10.1016/j.juro.2010.10.057. PubMedCentralCrossRefPubMed
- Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II