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Excellent Cancer Control at 10 Years
The technique of anatomical radical prostatectomy has been perfected
over the past 15 years.It is often incorrectly referred to as a
"nerve-sparing" procedure. This term, however, does not tell the
entire story and indeed sends the wrong message. Based upon
anatomical studies, the technique of radical prostatectomy was
modified in the following ways:
- accurate control of bleeding to enable the operation to be performed in a bloodless field
- intraoperative assessment of tumor extent and preservation or wide
excision of the nerves where necessary (prior to the advent of this
technique the nerves were never widely excised but merely cut and
left in place)
- precise preservation of the external sphincter
mechanism with functional reconstruction of the urinary tract to
preserve urinary control.
Over the past decade we have been able to
demonstrate that this technique is associated with less blood loss,
improved rates of urinary continence, and preservation of sexual
function in many patients.
At last, enough time has elapsed to evaluate the influence of
this technique on cancer control. We recently analyzed the results
on 955 men who underwent surgery between April 1982 and March 1991.
At 10 years 70% of all patients had an undetectable serum PSA, 7%
developed distant metastases, and 4% were found to have local
recurrence of their cancer. These are the best results ever
reported for radical prostatectomy. It is now clear that an
anatomical approach to radical prostatectomy provides excellent
cancer control while preserving quality of life.
- Partin, A.W., Pound, C.R., Clemens, J.Q, Epstein, J.I., and Walsh,
P.C.: Serum PSA after anatomic radical prostatectomy: The Johns
Hopkins Experience After 10 Years. Urol. Clinics N. Amer.
20:713-725, 1993.
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