April 16, 2014

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

Volume III, Spring 1994

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:

  1. accurate control of bleeding to enable the operation to be performed in a bloodless field
  2. 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)
  3. 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.

  1. 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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