Purpose: We evaluate cancer recurrence and survival rates following anatomic radical retropubic prostatectomy.
Materials and methods: From 1983 through August 1997, 1 surgeon performed anatomic radical retropubic prostatectomy in 1,778 men (mean age plus or minus standard deviation 63+/-7), using a unilateral or bilateral nerve sparing modification when feasible (93%). Postoperative adjuvant radiation therapy (mean dose 60 Gy.) was given to 4% of patients because of adverse pathological findings. Patients were followed with semiannual prostate specific antigen (PSA) tests and annual digital rectal examinations. Followup PSA 0.3 ng./ml. or greater was considered evidence of cancer recurrence. We used Kaplan-Meier product limit estimates to calculate 7-year cancer recurrence-free probabilities, prostate cancer specific survival and all cause survival (overall, and stratified by age, preoperative PSA, tumor grade and tumor stage). We used multivariate Cox proportional hazards models to determine clinical and pathological parameters that provided unique predictive information about cancer recurrence.
Results: The 7-year recurrence-free survival was significantly associated with lower preoperative PSA (estimated probability of nonprogression 76 to 93% for PSA less than 10), nonpalpable, localized clinical stage (79%), lower tumor grade (84 and 68% for well and moderately differentiated, respectively) and localized pathological stage (81% for pT1 or pT2) (all log rank test p <0.0001) but not age at surgery. All predictors except clinical stage and age remained significant within the multivariate model. Controlling for all other predictors, adjuvant radiation therapy in patients with unfavorable pathology was significantly associated with better recurrence-free survival (p=0.02). The estimated 7-year prostate cancer specific survival rate was 97% and the all cause survival rate was 90%. Cancer specific and all cause survival were significantly associated with lower grade and localized pathological stage (p <0.0001).
Conclusions: Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with good cancer control.