Radical Prostatectomy and the Control of Cancer

The approach to radical prostatectomy developed here at Johns Hopkins Hospital was based on better visualization and sound anatomical and pathologic principles. With this technique, we have been able to remove tumors with wider margins than was previously possible. All of us have been looking forward to long-term results on cancer control. Although a follow-up of 15 years is ideal to evaluate the efficacy of any form of treatment for prostate cancer, local recurrence of tumor is one measure that is meaningful sooner. Because two-thirds to three-quarters of all local recurrences occur in the first five years after radical prostatectomy, they are an especially useful yardstick.

We have just finished evaluating the first 600 men who underwent this procedure one and a half to eight years ago. The local recurrence rate at five years was only 4%, distant metastses occurred in 7% of patients, and 3% of men died of the disease. When this low rate of local recurrence is compared to previously published results of operations for similar stages of disease we find that our radical prostatectomy offers local control of tumor equal to or greater than any past operations. This confirms our impressions that better visualization enables the surgeon to perform a more precise operation with wider excision of tissue when necessary. Follow-up evaluations at 10 and 15 years will be carried out to confirm these findings.