耻骨后前列腺癌根治术（附27例报告）

目的总结经耻骨后前列腺癌根治术的治疗体会。方法2000年-2005年27例局限性前列腺癌患者，年龄60-71岁，平均66岁，术前PSA值4．8—37．5ng／mL。B期21例，G1期6例。采用开放性前列腺癌根治术治疗。结果本组患者高分化癌7例，中分化癌15例，低分化癌5例，术中出血300—1200mL，平均560mL，无周围脏器损伤及围手术期死亡病例，无吻合口漏尿。无吻合口狭窄、排尿困难，6例出现暂时性尿失禁，分别于术后1—2月恢复。9例术后1个月PSA降为0，随访未见升高，无需服用抗雄激素药物；其余18例患者间断性服用抗雄激素药物PSA下降至0．2ng／mL。术后16例维持阴茎勃起功能，所有病例均无瘤存活。结论耻骨后前列腺癌根治术中保留耻骨前列腺韧带及耻骨直肠悬带有助于减少并发症，取得较好的疗效。     

耻骨后解剖性根治性前列腺切除术的技术改进

目的探讨耻骨后解剖性根治性前列腺切除术的技术改进,减少手术并发症。方法前列腺癌患者98例,平均年龄64岁。术前PSA 2．0～108．6 ng／ml,平均18．5 ng／ml。A期6例、B期68例、C期24例。耻骨后解剖性根治性前列腺切除术改进步骤包括：保留耻骨前列腺韧带;应用集束血管钳协助完成耻骨后血管复合体（耻骨前列腺韧带＋背静脉复合体）的结扎切断;采用“4＋1”方法行膀胱尿道吻合术（“4”指重建的膀胱颈与尿道黏膜对黏膜2、5、7和10点4针吻合、“1”指将缝扎耻骨后血管复合体的2-0缝线于重建的膀胱颈12点、距吻合缘0．5～1．0 cm处浆肌层穿过,将重建膀胱颈与耻骨后血管复合体固定）。结果98例手术顺利,平均手术时间3 h。术中平均出血量约400 ml,输血37例。3例发生直肠损伤,术中行直肠修补,均Ⅰ期愈合。术后病理报告：盆腔淋巴结阳性12例,切缘阳性12例,精囊浸润13例。术后随访3～68个月。术后3个月内PSA下降至≤0．2 ng／ml者95例。保留尿管2～3周,术后6个月有Ⅱ度以下尿失禁者8例,7例于6个月内恢复控尿,1例于术后12个月时仍有Ⅰ度尿失禁。术后发生尿道狭窄4例,通过腔内治疗治愈。3例复发后给予间断全激素阻断治疗者分别于术后57、60、64个月死于肿瘤复发与转移。结论改进的耻骨后解剖性根治性前列腺切除术可缩短手术时间、减少手术并发症,可有效切除肿瘤,同时保留控尿功能。     

耻骨后前列腺癌根治术的技术改进(附32例报告)

目的　改进耻骨后前列腺癌根治术的手术技术 ,减少并发症。　方法　临床诊断为T1和T2 期前列腺癌患者 32例 ,平均年龄 6 8岁。改进耻骨后前列腺癌根治技术 ,包括广泛盆腔淋巴结清扫、保护神经血管束、缝扎背深静脉、多保留尿道后壁组织、膀胱尿道吻合时的膀胱颈部套叠等。　结果　手术时间平均 3.5h ,术中平均出血量 4 5 0ml,输血 1 7例。术后病理报告 :肿瘤局限于包膜内者30例 ,切缘阳性 1例 ,盆腔淋巴结转移 1例。随访 8～ 4 8个月 ,平均 2 2个月 ,均存活。PSA <1ng/ml者2 8例 ,1～ 3ng/ml者 4例。术后 3～ 6个月患者均恢复完全控尿。术后恢复勃起功能者 1 0 / 1 8(5 6 % )例。　结论　耻骨后前列腺癌根治术可有效切除肿瘤、保护控尿功能、保留性功能 ,是局限性前列腺癌的首选治疗方法。     

减少耻骨后前列腺癌根治术并发症的体会

目的探讨耻骨后前列腺癌根治术手术技巧及改进,减少手术并发症。方法对16例前列腺癌患者进行耻骨后前列腺癌根治术。结果16例患者手术顺利,平均手术时间3.5h,术中平均出血量700ml,术中无直肠损伤者。术后尿瘘1例,尿道狭窄1例,无尿失禁。结论有效控制背深静脉丛,精细解剖前列腺尖部,保护尿控神经,以及良好的尿道膀胱吻合术能有效地减少手术并发症。     

尿控技术用于经耻骨后前列腺癌根治术80例分析

目的探索保留尿道括约肌手术技巧在前列腺癌根治术中的应用效果.方法本组80例前列腺癌患者,年龄66岁(范围59~75岁);79例前列腺肿瘤限于T2b期以内,1例T3期;78例因PSA升高行术前经直肠超声波(TRUS)引导下的前列腺穿刺活检,Gleason分级3~7分,另2例为TURP后偶发癌;PSA平均8.5ng/ml(范围2.7~44.5 ng/ml).手术前均无尿失禁情况.手术技巧:处理阴茎背深静脉丛采用集束“8”字缝扎;处理前列腺尖部时紧贴前列腺表面分离,并保留前列腺部尿道0.5~1cm;保留膀胱颈部.结果手术后随访12~48个月,18例生化复发,6例尿失禁.结论尿道外括约肌的保留能够减少前列腺癌根治术后尿失禁的发生.     

大体积良性前列腺增生患者高值PSA临床分析

目的　探讨大体积良性前列腺增生 (BPH)患者高值血清前列腺特异抗原 (PSA)的来源。　方法　对 2 7例术前PSA值 8.1～ 75 .1ng/ml,直肠指诊前列腺≥Ⅲ° ,超声测量前列腺体积 >5 0ml,无前列腺癌 (PCa)迹象的排尿困难患者 ,采用耻骨上前列腺切除术及术后PSA追踪检测方法 ,分析术后PSA值变化的原因以及术前高值PSA的来源。　结果　 2 7例切除腺体 4 0～ 1 85g ,平均 82 .7g。病理检查 2例发现PCa灶 ,2 5例未发现PCa灶。术后 1个月内 1例有PCa灶者PSA上升 ,2 6例迅速下降至正常范围。 2 4例获随访 1 7～ 5 7个月 ,PSA 0 .0 8～ 2 .39ng/ml,平均 1 .1 6ng/ml。　结论　大体积BPH患者的高值PSA多源于前列腺移行区增生腺体 ,而非源于外周区     

经直肠超声引导下前列腺6点穿刺活检术诊断单纯前列腺特异抗原增高型前列腺癌

目的探讨经直肠超声引导下前列腺6点穿刺活检术诊断单纯前列腺特异性抗原(PSA)增高型前列腺癌的临床应用价值。方法回顾分析84例接受经直肠超声引导下前列腺6点穿刺活检术的患者资料。所有患者直肠指诊及常规超声检查结果均为阴性。根据血清PSA分为4组:A组24例,PSA 4~20ng/ml;B组8例,PSA 21~30ng/ml;C组32例,PSA 31~100ng/ml;D组20例,PSA100ng/ml。结果 84例患者穿刺术后均未出现并发症。49例穿刺病理诊断为前列腺癌(49/84,53.33%),其中A组检出1例(1/49,2.04%),B组检出4例(4/49,8.16%),C组检出24例(24/49,48.98%),D组检出20例(20/49,40.82%)。A、B、C、D组中前列腺穿刺活检阳性率分别为4.17%(1/24)、50.00%(4/8)、75.00%(24/32)、100%(20/20),差异有统计学意义(χ2=47.143,P0.05)。结论经直肠超声引导下前列腺6点穿刺活检术并发症少,对单纯PSA增高型前列腺癌具有较高的阳性率。     

非气腹腹腔镜下前列腺癌根治术11例报告

目的：探讨非气腹腹腔镜下前列腺癌根治术的可行性及疗效。方法2012年7月～2013年6月,行非气腹腹腔镜下前列腺癌根治术11例。前列腺特异抗原（PSA）（19．6±17．2） ng/ml,前列腺体积33～78 ml,平均41 ml。临床分期cT1期3例,cT2期6例,cT3期2例。取耻骨上正中切口3～5 cm,用手指钝性分离膀胱前间隙。在腹腔镜或示指引导下于双侧麦氏点下2 cm与脐下弧形穿出3个操作通道。应用悬吊器械提拉下腹壁创造操作的空间,30°腹腔镜通过脐部的通道进入,术者通过两侧的通道及下腹部的小切口进入器械操作。手术操作与传统的腹腔镜下前列腺癌根治术相同。结果11例手术顺利,手术时间（227±61） min,术中出血量（360±101） ml,无直肠损伤等严重并发症。术后病理均为前列腺腺癌,无切缘阳性。随访1～11个月,平均4个月,排尿通畅,无尿失禁。 PSA 0～0．21 ng/ml,平均0．11 ng/ml。结论非气腹腹腔镜下前列腺癌根治术微创、安全、有效。     

保留耻骨前列腺韧带在耻骨后根治性前列腺切除术控尿中的作用

目的 探讨耻骨后根治性前列腺切除术中保留耻骨前列腺韧带(PL)的控尿作用.方法前列腺癌患者74例.年龄52～73岁,平均65岁.术前实验室检查PSA 2.0～23.6 ng/ml,平均16.5 ng/ml.其中64例行经直肠超声引导下前列腺系统穿刺活检,病理证实为前列腺癌;10例行TURP后病理发现前列腺癌.74例均行盆腔MRI及全身骨扫描未见前列腺外转移病灶.A期6例、B期68例.手术方法:常规行双侧盆腔淋巴结清扫,锐性切开盆内筋膜至PL侧缘,50例保留PL,在尿道前方紧贴前列腺尖部的弧形缘放置集束血管钳,控制耻骨后血管复合体(包括PL与背静脉复合体);对照组24例紧贴耻骨切断PL,在尿道前方紧贴前列腺尖部的弧形缘放置集束血管钳,控制背静脉复合体.在集束钳下方用1-0可吸收线分别贯穿缝扎集束血管钳控制的组织,沿前列腺的弧形切断该束组织达前列腺尖部与尿道连接处.离断尿道.采用"网球拍"式的膀胱颈重建.整形后的膀胱颈与尿道黏膜对黏膜于2、5、7和10点分别吻合4针,将保留在复合体上的1-0缝线于重建膀胱颈的12点、距吻合缘0.5～1.0 cm处浆肌层贯穿缝扎,将其与复合体结扎固定.术后保留尿管2周.结果 74例手术均顺利.随访3～12个月.保留PL组及切断PL组年龄分别为(61.3±2.4)和(60.8±2.1)岁,实验室检查PSA分别为(14.3±1.2)和(14.7±1.3)ng/ml,手术时间为(110.5±10.4)和(109.7±10.6)min,术中出血量为(250.5±23.4)和(253.4±22.3)ml,切缘阳性率为6%(3/50)和8%(2/24);2组比较差异均无统计学意义(P>0.05).保留PL组与切断PL组术后拔除尿管不同时间的控尿率分别为:即刻26%(13/50)和0%(0/24),1个月时为50%(25/50)和12%(3/24),3个月时为80%(40/50)和42%(10/24),6个月时为96%(48/50)和67%(16/24),12个月时为100%(50/50)和75%(18/24);2组比较差异均有统计学意义(P<0.05). 结论 PL在耻骨后根治性前列腺切除术后控尿中发挥较大作用,术中应积极保留.     

经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的初步经验

目的探讨经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的疗效和并发症。方法本组前列腺癌患者5例。年龄61￣83岁,平均70.4岁。临床分期T2bN0M0者2例,T3aN0M0者3例。Gleason评分6分者2例,7分者1例,8分者2例。术前前列腺特异性抗原(PSA)4.5￣17.5ng/ml。T3a期患者植入治疗前先行内分泌治疗。术前制定治疗计划,经直肠超声引导下经会阴125I粒子永久植入操作。术后观察PSA水平变化,连续3次PSA升高即为生化复发,观察术后尿路和直肠并发症发生情况。结果5例患者均术后恢复顺利。术后随访18个月,PSA均明显下降,PSA为0.1ng/ml者3例,0.01ng/ml者1例,0.04ng/m1者1例。5例患者术后均出现不同程度的尿路刺激症状,但6个月后逐渐好转。4例术后出现排便次数增多,术后3个月均好转。未发现尿失禁、直肠溃疡等并发症。结论经直肠超声引导下经会阴125I粒子永久植入治疗前列腺癌的疗效确切,创伤较小。     

Screening with low PSA cutoff values results in low rates of positive surgical margins in radical prostatectomy specimens

BACKGROUND: In the literature, positive margins in radical prostatectomy specimens, the rate of which ranges between 7% and 46%, are associated with adverse patient survival. The aim of the present study was to determine the predictive value of preoperative serum prostate specific antigen (PSA) values for the rate of positive margins in radical retropubic prostatectomy. METHODS: The study included a cohort of 845 patients who underwent radical retropubic prostatectomy between October of 1993 and December of 1999. All patients were stratified in groups on the basis of their preoperative PSA values: PSA group I, 0-1.99 ng/ml; PSA group II, 2-3.99 ng/ml; PSA group III, 4-5.99 ng/ml; PSA group IV, 6-7.99 ng/ml; PSA group V, 8-9.99 ng/ml; and PSA group VI, >10 ng/ml. For each group, the pathologic stage, Gleason score, and the incidence of positive margins were analyzed. For statistical analysis, the Mann Whitney U-test was used. RESULTS: Our data show a significantly higher rate of organ-confined prostate cancers and a significantly lower rate of positive surgical margins in patients with preoperative total PSA values of less than 4 ng/ml compared with patients with higher preoperative total PSA levels. CONCLUSION: As tumor stage and surgical margin status after radical prostatectomy are important predictors of the likelihood of PSA recurrence, which necessitates additional therapy, these findings support the concept of PSA screening by using low PSA cutoff levels.     

Radical prostatectomy by the retropubic,perineal and laparoscopic approach: 12 years of experience in one center

OBJECTIVES: We retrospectively evaluated the oncological outcome of radical prostatectomy performed by the retropubic, perineal and laparoscopic approaches. METHODS: From 1988 to 2000, 401 patients underwent radical prostatectomy for localized prostate cancer by the retropubic, perineal or laparoscopic approach. Age, clinical stage, preoperative PSA and Gleason score of positive biopsies were noted. Operating time, complication rate, transfusion rate, length of hospital stay, catheterization time and pathological results were reviewed. Kaplan-Meier analysis was used to evaluate the likelihood of biochemical recurrence (PSA > or =0.2 ng/ml). RESULTS: There were no significant differences between the three groups regarding preoperative characteristics, except for PSA (21.4 ng/ml, 13.2 ng/ml, and 11.6 ng/ml for the retropubic, perineal, and laparoscopic approach, p<0.05) and the frequency of stage T1c tumors (31.7%, 47.1% and 63.5%, respectively, p<0.05). The operating time was significantly longer in the laparoscopic approach (285 min) compared to the retropubic and perineal techniques (197 min and 178 min, respectively). The retropubic approach was associated with a higher transfusion rate (26.2% versus 15.9% and 2.9% with the perineal and laparoscopic approaches), longer bladder catheterization time (15.9 days versus 11.7 days and 6.8 days, respectively), and longer hospital stay (15.2 days versus 8.5 days and 7.4 days, respectively) (p<0.05 for each). With the retropubic, perineal and laparoscopic approaches, medical complication rates were 8.3%, 4.2% and 5.1%, and surgical complication rates were 16.5%, 12.7% and 13.1%, respectively. The rates of pathological stage pT2 tumors were 62.1%, 72.2% and 75.9%, in the retropubic, perineal and laparoscopic groups, respectively. Positive surgical margins in pT2 tumors were noted in 19%, 14% and 22%, respectively. The actuarial 3-year recurrence-free survival rates were not significantly different between the three techniques (75%, 85.2% and 84.1%, respectively; 91.7%, 95.8% and 90.4% among patients with organ-confined tumors). CONCLUSION: Despite changes in patient selection criteria over time, and the relatively short follow-up, this study showed no significant difference in oncologic outcome between the retropubic, perineal and laparoscopic approaches to radical prostatectomy.     

A survey of radical surgery without neoadjuvant therapy for patients with stage B and C prostatic carcinoma

There has been much controversy regarding radical surgery for both localized and locally extensive carcinoma of the prostate. We analyzed the outcome of radical prostatectomy and the preoperative evaluation in order to assess the indication of radical prostatectomy. Fifty-six patients with clinical stage B or C prostate cancer were treated by radical prostatectomy without neoadjuvant therapy. Endocrine therapy was added to the non-curative cases postoperatively. Preoperative evaluation was compared with pathological results and survival, and furthermore the usefulness of the preoperative PSA and PSA half-life were investigated. The mean follow-up period was 44.5 months. The accuracy of the grade and the clinical stage were 58.9% and 23.2%, respectively. Organ-confined disease was seen in patients with an initial PSA level less than 30 ng/ml. Postoperative PSA half-life is significantly prolonged in cases with poorly differentiated adenocarcinoma or lymph node involvement and may be a predictor of PSA failure. The cause-specific 5-year survival rates were 92.7% on the whole, 92.9% for well differentiated, 96.7% for moderately differentiated, 85.7% for poorly differentiated, 100% for stage B1, 95.0% for stage B2 and 86.8% for stage C. These results indicated that patients with an initial PSA level of less than 30 ng/ml will benefit from radical prostatectomy.     

Surgical margins in radical prostatectomy: a comparison between retropubic and laparoscopic surgery

Objectives To compare positive surgical margins in both radical retropubic prostatectomies and laparoscopic surgery in two reference centres in Brazil. Materials and methods One hundred and seventy nine pathological studies from patients, who underwent radical prostatectomy due to prostate adenocarcinoma, 89 submitted to retropubic surgery and 90 to laparoscopic surgery, were analyzed. Inclusion criteria Patients with PSA ≤15 ng/ml, and a Gleason score ≤7 at the prostate biopsy, maximum T2 clinical staging. Results There has been surgical margin compromising in 41.57% of the patients submitted to retropubic radical prostatectomy (RRP), 34.21% of which were at pT2 stage and 84.61% were at pT3 stage. In patients submitted to laparoscopic radical prostatectomy (LRP) positive surgical margin was found at 24.44% of the cases: 20.98% of which were at pT2 stage and 55.55% at pT3 stage. Conclusions In the analyzed samples, proportion of positive surgical margin was higher in RRP than in LRP (P = 0.023). A higher number of patients on a randomized prospective study would be necessary for a better comparison between the groups.     

Effect of perioperative blood transfusion on prostate cancer recurrence

BACKGROUND: Transfusion may predispose patients to an increased risk of tumor recurrence following solid organ surgery. Lung and colon cancer studies suggest that blood transfusions promote tumor growth or distant metastasis possibly due to immunosuppression. Blood loss can be high during radical retropubic prostatectomy necessitating intraoperative and postoperative blood transfusion. The impact of blood transfusion on recurrence risk after radical retropubic prostatectomy remains uncertain. OBJECTIVE: To determine the influence of allogeneic or autologous blood transfusion on prostate cancer recurrence in men undergoing radical retropubic prostatectomy and assess their prognostic significance using serum prostate-specific antigen (PSA) as an intermediate endpoint. METHODS: Six hundred eleven men treated from 1987 to the present have had all clinical and follow-up data entered prospectively into a clinical database; 242 (40%) did not receive blood transfusion, 252 (41%) received autologous blood transfusion, and 117 (19%) received allogeneic blood transfusion. Biochemical failure was defined as PSA > 0.3 ng/ml on any follow-up visit. ANOVA, chi-square, and survival analyses were used to evaluate clinical characteristics and biochemical progression-free survival. RESULTS: Patients participated for a mean of 44 months, range 1 to 170 months, until biochemical progression (78) or July 1, 2005 (533). Average estimated blood loss was 929 ml, 1573 ml, and 2,818 ml in the no blood transfusion, autologous blood transfusion, and allogeneic blood transfusion groups, respectively (P = 0.001). Patients in the allogeneic transfusion group were older, had higher preoperative PSA, higher stage disease, and greater blood loss. Biochemical failure rates were similar in the 3 groups (P = 0.42). Biochemical failure at 5 years occurred in 14% of men who did not receive blood transfusion, 10% of men who received autologous blood transfusion, and 16% of men who received allogeneic blood transfusion. No patient suffered clinical progression or prostate cancer death. CONCLUSIONS: Autologous or allogeneic blood transfusions do not appear to influence the risk of biochemical failure in men with clinically localized prostate cancer treated with radical retropubic prostatectomy.     

Predictive value of prostate specific antigen density in the detection of prostate cancer in patients with elevated prostate specific antigen levels and normal digital rectal findings or stage A prostate cancer

We compared the usefulness of PSA and PSA density (PSAD) in diagnosing prostate cancer in 102 men who had a PSA value higher than 4.0 ng/ml and normal digital rectal examination and who had undergone transrectal ultrasonography-guided systematic sextant biopsies of the prostate between August 1996 and October 1999. In addition, for a group of 53 patients who underwent retropubic simple prostatectomy, PSA, PSAD and PSA transition zone (PSA-TZ) examination results for those with stage A prostate cancer were compared with the results for those with benign prostatic hyperplasia (BPH). Of the former 102 men, 20 (19.6%) had prostate cancer. There was no significant difference in mean PSA level between patients with negative and those with positive biopsy results (mean 9.3 and 11.8, respectively, p = 0.295), but the mean PSAD of patients with positive biopsy results was significantly higher than that of those with negative results (mean 0.55 and 0.29, respectively, p = 0.0007). Of the 53 men who underwent retropubic simple prostatectomy, 10 (18.9%) were diagnosed with stage A prostate cancer. There was no significant difference in mean PSA, PSAD and PSA-TZ examination results between patients with BPH and those with stage A prostate cancer. For all 102 patients and for 71 patients with PSA levels of 4.1-10.0 ng/ml, a PSAD cutoff value of 0.1 reduced the number of biopsies 15.7% (16 of 102 cases), and 22.5% (16 of 71 cases), respectively. These results suggest that by measurement of PSAD some patients with benign disease could be spared a biopsy which would have been performed based on PSA results alone.     

Value of PSA in the staging of prostatic cancer]

The clinical value of Serum Prostate Specific Antigen (PSA) in the staging of prostatic carcinoma was evaluated in 62 patients who underwent radical retropubic prostatectomy. Preoperative levels of PSA were compared with the final pathological stage obtained from all surgical specimens examined for capsular penetration, seminal vesical invasion and lymph node involvement. PSA level was closely correlated with the volume and the stage of the prostatic carcinoma. 93% of the patients with PSA < or = 10 ng/ml had tumor confined to the gland. All patients with PSA > 20 ng/ml had extraprostatic tumor extension (stage C or D). Patients with histologically proved prostatic carcinoma, PSA > 20 ng/ml and negative bone scan can be assumed to have extraprostatic disease and/or lymphatic involvement. Patients with PSA (drawn in the requested conditions) < or = 10 ng/ml can be considered to have organ confined disease, and can be spared a bone scintigraphy. Our study indicate an increasing role of PSA in the clinical staging of patients with prostatic carcinoma.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.     

Is seminal vesicle ablation mandatory for all patients undergoing radical prostatectomy? A multivariate analysis on 1283 patients

OBJECTIVE: With a shift in prostate cancer stage and a majority of patients operated nowadays with PSA levels <10 ng/ml, rates of seminal vesicle (SV) invasion found on radical prostatectomy specimens have decreased as compared to historical data. Since SV-sparing surgery may possibly have an influence on post-operative erectile dysfunction and urinary recovery, we tried to determine which patients could be safely spared SV excision during radical prostatectomy. MATERIAL AND METHODS: We used preoperative data from 1283 patients operated by radical retropubic prostatectomy--777 with serum PSA <10.0 ng/ml--to predict SV invasion on final pathological examination. Variables analyzed included age, digital rectal examination, serum PSA, biopsy Gleason score and percentage of biopsy cores invaded by prostate cancer. Statistical analysis included univariate, multivariate logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Out of 1283 patients, 137 (10.6%) had SV involvement, 41/777 (5.2%) with PSA <10.0 ng/ml, 16.1% in the 10-20 ng/ml range and 26.2% when PSA was >20 ng/ml. Percentage of biopsies affected by prostate cancer and biopsy Gleason score were significant predictors of SV invasion in multivariate analysis, both in the entire population and in the subset of patients with PSA <10.0 ng/ml (p < 0.0001). Probability graphs created for patients with PSA <10 ng/ml indicate a risk of seminal invasion <5% when Gleason score on biopsy is <7 or when the percentage of biopsies affected by cancer is <50%. CONCLUSIONS: Resection of SV might not be "oncologically" necessary in all patients undergoing RP when PSA levels are below 10 ng/ml except when biopsy Gleason score is > or =7 or when more than 50% of prostate biopsy cores show cancer involvement. SV-sparing surgery could be prospectively compared to standard retropubic prostatectomy in selected individuals analyzing potential benefits on erectile function and urinary continence.