J Korean Med Assoc.  2015 Jan;58(1):15-20. 10.5124/jkma.2015.58.1.15.

Surgical treatment for prostate cancer

• Choi DK
• Seo SI

• KMID: 2149278
• DOI: http://doi.org/10.5124/jkma.2015.58.1.15

Abstract

With the recent increase in the elderly population, and the Westernization of the diet and increased consumption of meat products, a significant rise in the incidence of prostate cancer has been noted in the Republic of Korea. In cases with localized prostate cancer and sufficiently long life expectancy, the standard treatment is surgical resection of the prostate. Such surgical treatment is so far the only modality demonstrated through randomized prospective studies to be beneficial in terms of disease-specific survival; this procedure involves not only surgical removal of the prostate but also pelvic lymphadenectomy for accurate staging and neurovascular bundle preservation to aid in postoperative functional recovery. Prostatectomy can be carried out either with an open technique, laparoscopically, or under robot assistance. Reviews of the literature and meta-analyses have shown that laparoscopic and robot-assisted procedures offer significant reductions in blood loss and transfusion rates and advantages in terms of recovery from postoperative complications such as incontinence and impotence over open prostatectomy. However, no long-term oncologic outcomes are available for laparoscopic or robot-assisted procedures, and the long-term prevalence of incontinence and impotence for these two methods doesnot differ significantly from those for open prostatectomy, despite the laparoscopic and robot-assisted procedures being far more costly. Therefore, surgical treatment of prostate cancer should be carefully decided on following ample deliberation of various factors including the stage, age, comorbidities, and economic status of the patient and provision of sufficient information to the patient.

Keyword

Prostatic neoplasms; Prostatectomy; Urologic surgical procedures

MeSH Terms

Aged
Comorbidity
Diet
Erectile Dysfunction
Humans
Incidence
Life Expectancy
Lymph Node Excision
Male
Meat Products
Postoperative Complications
Prevalence
Prostate
Prostatectomy
Prostatic Neoplasms*
Republic of Korea
Urologic Surgical Procedures

Reference

1. Song K, Song C, Ahn H. Continuing trends of the clinical parameter migration in patients with prostate cancer in Korea. Korean J Urol. 2007; 48:574–578.

2. Kim D, Choi D, Lim JH, Yoon JH, Jeong IG, You D, Hong JH, Ahn H, Kim CS. Changes in prostate cancer aggressiveness over a 12-year period in Korea. Korean J Urol. 2012; 53:680–685.

3. Singh J, Trabulsi EJ, Gomella LG. Is there an optimal management for localized prostate cancer? Clin Interv Aging. 2010; 5:187–197.

4. Bishoff JT, Motley G, Optenberg SA, Stein CR, Moon KA, Browning SM, Sabanegh E, Foley JP, Thompson IM. Incidence of fecal and urinary incontinence following radical perineal and retropubic prostatectomy in a national population. J Urol. 1998; 160:454–458.

5. Holmberg L, Bill-Axelson A, Helgesen F, Salo JO, Folmerz P, Haggman M, Andersson SO, Spangberg A, Busch C, Nordling S, Palmgren J, Adami HO, Johansson JE, Norlen BJ. Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002; 347:781–789.

6. Blute ML, Bergstralh EJ, Iocca A, Scherer B, Zincke H. Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. J Urol. 2001; 165:119–125.

7. Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol. 2003; 169:517–523.

8. Siddiqui SA, Sengupta S, Slezak JM, Bergstralh EJ, Leibovich BC, Myers RP, Zincke H, Blute ML. Impact of patient age at treatment on outcome following radical retropubic prostatectomy for prostate cancer. J Urol. 2006; 175:952–957.

9. Bianco FJ Jr, Scardino PT, Eastham JA. Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function ("trifecta"). Urology. 2005; 66:83–94.

10. Albertsen PC, Hanley JA, Gleason DF, Barry MJ. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA. 1998; 280:975–980.

11. Tewari A, Johnson CC, Divine G, Crawford ED, Gamito EJ, Demers R, Menon M. Long-term survival probability in men with clinically localized prostate cancer: a case-control, propensity modeling study stratified by race, age, treatment and comorbidities. J Urol. 2004; 171:1513–1519.

12. Bill-Axelson A, Holmberg L, Filen F, Ruutu M, Garmo H, Busch C, Nordling S, Haggman M, Andersson SO, Bratell S, Spangberg A, Palmgren J, Adami HO, Johansson JE. Scandinavian Prostate Cancer Group Study Number 4. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst. 2008; 100:1144–1154.

13. Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, Huland H. Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol. 2003; 43:113–118.

14. Lepor H, Nieder AM, Ferrandino MN. Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol. 2001; 166:1729–1733.

15. Ryu J, Kwon T, Kyung YS, Hong S, You D, Jeong IG, Kim CS. Retropubic versus robot-assisted laparoscopic prostatectomy for prostate cancer: a comparative study of postoperative complications. Korean J Urol. 2013; 54:756–761.

16. So BK, Choi JD, Lee SY, Kim HS, Park SY, Seo SI. Experience of 100 laparoscopic radical prostatectomies performed by a single surgeon: an analysis of surgical and functional outcomes. Korean J Urol. 2011; 52:517–523.

17. Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean J Urol. 2011; 52:437–445.

18. Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009; 55:1251–1265.

19. Masterson TA, Bianco FJ Jr, Vickers AJ, DiBlasio CJ, Fearn PA, Rabbani F, Eastham JA, Scardino PT. The association between total and positive lymph node counts, and disease progression in clinically localized prostate cancer. J Urol. 2006; 175:1320–1324.

20. Wagner M, Sokoloff M, Daneshmand S. The role of pelvic lymphadenectomy for prostate cancer: therapeutic? J Urol. 2008; 179:408–413.

21. Shikanov S, Woo J, Al-Ahmadie H, Katz MH, Zagaja GP, Shalhav AL, Zorn KC. Extrafascial versus interfascial nerve-sparing technique for robotic-assisted laparoscopic prostatectomy: comparison of functional outcomes and positive surgical margins characteristics. Urology. 2009; 74:611–616.

22. Ponnusamy K, Sorger JM, Mohr C. Nerve mapping for prostatectomies: novel technologies under development. J Endourol. 2012; 26:769–777.

23. Kamat AM, Jacobsohn KM, Troncoso P, Shen Y, Wen S, Babaian RJ. Validation of criteria used to predict extraprostatic cancer extension: a tool for use in selecting patients for nerve sparing radical prostatectomy. J Urol. 2005; 174:1262–1265.

24. Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, Muramoto M, Reuter VE, Wheeler TM, Scardino PT. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol. 2004; 171:1844–1849.

25. Wright JL, Izard JP, Lin DW. Surgical management of prostate cancer. Hematol Oncol Clin North Am. 2013; 27:1111–1135.

26. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H. Retropubic, laparoscopic, and robotassisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55:1037–1063.

27. Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ, Patel VR. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol. 2010; 24:2003–2015.

28. Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, Gettman MT. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int. 2009; 103:448–453.

29. Tewari A, Srivasatava A, Menon M. Members of the VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003; 92:205–210.