Complications Of Open Radical Retropubic Prostatectomy In Potential Candidates For Active Monitoring

UroToday - Active monitoring with delayed intervention for prostate cancer (CaP) is an increasingly utilized strategy. However, due to a stage shift migration, men are now diagnosed with much earlier and perhaps more indolent CaP. In the online version of Urology, Dr. Stacy Loeb and associates of Dr. William Catalona evaluate the surgical complications of their patients who underwent radical prostatectomy (RP), but were candidates for active monitoring (AM).


Between 1983 and 2006, 4,265 men underwent RP by Dr. Catalona. The authors identified men from their surgical series that met one of three published sets of criteria for AM: the Patel definition of Gleason score 7 or less and no significant comorbidities, the Choo definition of clinical stage T1b-T2bN0M0, Gleason 7 or less, and a PSA of 15ng/ml or less, or the Mohler definition of clinical stage T1c CaP. They found 3,458, 3,533, and 2,338 men, respectively who met these AM definitions. Oncologic, potency and continence were evaluated longitudinally. Stratified by age, there were 298 men (7%) in their thirties and forties, 1,496 men (35%) in their fifties, 1,934 men (45%) in their sixties, and 536 men (13%) in their 70's or older.


By the Patel criteria, mean preoperative PSA was 7.1ng/ml. The database identified most of the patients as Caucasian with a Gleason score of 6 or less and clinical stage T1c or T2 treated with bilateral nerve sparing surgery. At a mean follow-up of 5 years, 90% were continent, 62% were potent and 7% had surgical complications. By the Choo criteria, mean PSA was 5.9ng/ml and at a mean follow-up of 54 months, 90% were potent, 63% were continent, and 7% had complications. By the Mohler criteria, mean PSA was 6.7ng/ml and at a mean follow-up of 42 months, 90% were continent, 63% were potent, and 5% had surgical complications. The risk of erectile dysfunction increased with increasing age, preoperative PSA, biopsy Gleason score and clinical stage. Medical comorbidities and non nerve-sparing surgery were significantly associated with potency. The risk of surgical complications was directly related to increasing age, PSA and clinical stage, with age the strongest predictor of continence. Men in their forties had continence rates of about 96%, potency rates of 93%, and complication rates of about 4%. Men in their fifties had similar outcomes, but the potency rates were less at 80%. Men in their sixties had continence rates of 94% and potency of up to 69%. Over age 70 men had continence of 70% and potency of 46-59% with a surgical complication rate of up to 13%. These data support excellent outcomes, but some decrease in outcomes with increasing age and a higher complication rate in older patients.


Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS


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