[Perineal radical prostatectomy as monotherapy: ten-year experience]

To evaluate the clinical and oncological results of perineal radical prostatectomy (PRP) as monotherapy.

We include our initial series of 115 consecutive patients with prostate cancer without neoadjuvant hormonal therapy undergoing perineal radical prostatectomy as monotherapy from November 92, when we decide to abandon laparoscopic lymphadenectomy in patients deemed at low risk of N+ (PSA = 10 and Gleason score = 7 and organ confined or suspicion of minimal extra capsular extension on ultrasound). Functional results are compared with the first 115 consecutive patients in our own series of retropubic radical prostatectomy (RRP). No patient received adjuvant therapy and deferred intermittent androgen blockade was only applied when patients with biochemical progression reached a PSA of 4 ng/ml.

After a mean follow-up of 57.7 months (3-130) we obtained: global survival 98.3%, disease specific 100%; biochemical progression 13.9% (161, pT 2 (5.2%), 32pT3a (21.8%), 7pT3b-pT4a (71.4%)). Incidence of positive margins 41.7% (52.1% unifocal with a progression rate of only 12%). 87% of the patients did not need transfusion during or after surgery. Urinary continence was 96.5% and the probability of potency preservation was 34.7%. Among 16 patients with biochemical progression, only 4 required deferred intermittent androgen blockade (1 cycle in 3 patients and two in the remainder).

PRP without lymphadenectomy as monotherapy offers excellent oncological and functional results equivalent to RRP, which favour the perineal approach: short-term operative times, lower transfusion rate, possibility of regional anesthesia, better tolerance with minimal analgesia requirements, and shorter hospital stay. Watchful waiting in the follow-up of patients in biochemical progression with a deferred intermittent androgen blockade regimen offers an excellent quality of life, with survivals similar to any other therapeutic option after this follow-up time.