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The anatomic radical perineal prostatectomy: an outcomes-based evolution.
Eur Urol. 2007 Jul; 52(1):81-8.EU

Abstract

OBJECTIVE

Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck.

METHODS

Objective parameters and physician-reported clinical outcomes are collected prospectively on 704 consecutive patients undergoing radical perineal prostatectomy (RPP) by one surgeon. The technique described herein is the current state of evolution of RPP. The enclosed digital video is edited from two recent nerve-sparing RPPs.

RESULTS

Freedom from prostate-specific antigen (PSA) detectability by stage is 94.5%, 80.0%, and 81.5% for organ-confined, specimen-confined, and margin-positive disease with actual 5-yr follow-up. Margins are positive in 18% of cases. By 1, 3, 6 mo and 1 yr, 52%, 71%, 85%, and 94% of the men are free from using pads. Although >97% of nerve-spared patients have spontaneous erections, >80% can penetrate to complete intercourse.

CONCLUSIONS

This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The anatomic RPP is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer.

Authors+Show Affiliations

Northern Institute of Urology, 4100 Park Forest Drive, Suite 200, Traverse City, MI 49684, USA. mikeharris@chartermi.net

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17084506

Citation

Harris, Michael J.. "The Anatomic Radical Perineal Prostatectomy: an Outcomes-based Evolution." European Urology, vol. 52, no. 1, 2007, pp. 81-8.
Harris MJ. The anatomic radical perineal prostatectomy: an outcomes-based evolution. Eur Urol. 2007;52(1):81-8.
Harris, M. J. (2007). The anatomic radical perineal prostatectomy: an outcomes-based evolution. European Urology, 52(1), 81-8.
Harris MJ. The Anatomic Radical Perineal Prostatectomy: an Outcomes-based Evolution. Eur Urol. 2007;52(1):81-8. PubMed PMID: 17084506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The anatomic radical perineal prostatectomy: an outcomes-based evolution. A1 - Harris,Michael J, Y1 - 2006/10/30/ PY - 2006/05/04/received PY - 2006/10/19/accepted PY - 2006/11/7/pubmed PY - 2007/9/14/medline PY - 2006/11/7/entrez SP - 81 EP - 8 JF - European urology JO - Eur Urol VL - 52 IS - 1 N2 - OBJECTIVE: Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck. METHODS: Objective parameters and physician-reported clinical outcomes are collected prospectively on 704 consecutive patients undergoing radical perineal prostatectomy (RPP) by one surgeon. The technique described herein is the current state of evolution of RPP. The enclosed digital video is edited from two recent nerve-sparing RPPs. RESULTS: Freedom from prostate-specific antigen (PSA) detectability by stage is 94.5%, 80.0%, and 81.5% for organ-confined, specimen-confined, and margin-positive disease with actual 5-yr follow-up. Margins are positive in 18% of cases. By 1, 3, 6 mo and 1 yr, 52%, 71%, 85%, and 94% of the men are free from using pads. Although >97% of nerve-spared patients have spontaneous erections, >80% can penetrate to complete intercourse. CONCLUSIONS: This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The anatomic RPP is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/17084506/The_anatomic_radical_perineal_prostatectomy:_an_outcomes_based_evolution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(06)01340-6 DB - PRIME DP - Unbound Medicine ER -