October 30, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume I, Spring 1988

CANCER CONTROL HAS BEEN EFFECTIVE

The goal of any cancer operation is the complete excision of all tumor with the minimum injury possible to surrounding tissue. When this operation was developed over five years ago, it was based upon the anatomical observation that the nerves that control erection are located outside of the prostate and its surrounding fascia. Previously no one knew where these nerves were located. Much to our surprise, when we reviewed old surgical specimens we learned that the nerves were usually not removed previously with the cancer. Instead, they were merely injured and left behind. Thus, in standard radical prostatectomies in the past, these nerves were not resected. However, based upon our anatomical observations, these nerves can now be identified at the time of surgery and either preserved or widely resected with the specimen. These observations have actually made the operation more radical and more complete, where indicated, than previously possible.

Among the large number of patients who have been followed from one to slightly longer than five years, we now have information regarding the success rate for cancer control. Of 320 men followed up to five years, only 10 have developed distant spread of their cancer as the first sign of failure. All 10 had extensive tumor that penetrated into the soft tissue surrounding the prostate and in eight the tumor was so extensive that it was necessary to excise one or both nerve bundles. Three other patients have developed local recurrence of their cancer as the first sign of treatment failure. Thus, only 13 men (4 percent) who have been followed from one to five years have developed progression of the disease. These early results are excellent, but longer follow-up of patients is necessary to confirm this impression.

Based upon our experience with radical prostatectomy prior to the development of the nerve-sparing technique, we know that approximately 10 percent of patients will develop local recurrence as the first sign of failure in the first five years postoperatively and that in the succeeding five years an additional 5 percent may have a similar outcome. Thus, most local failures are seen within the first five years. We are monitoring this closely in our group of patients and more time must elapse to determine whether the total local recurrence rate will exceed 29 more patients i.e. 10 percent over the next four years. Based upon the trends observed to this point, however, this does not seem likely.

 

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