Total prostatectomy for clinically localized prostate cancer: long-term surgical results and current morbidity

The outcome for the first 57 successive patients who underwent total perineal prostatectomy for clinically localized prostate cancer at the Virginia Mason Clinic and who have been followed up for a minimum of 15 years is reviewed for evaluation of the long-term impact of this operation on the disease. Twenty percent of the patients had pathologic stage C disease. Recurrence developed in 11 of the 55 patients (20%) who could be evaluated, and death from prostate cancer occurred in 6 (11%) during this interval. The actual observed overall survival at 15 years or more was 60%, the actuarial survival 67%, and the cause-specific survival 89%. The current morbidity of this operation was evaluated by review of the last 50 consecutive patients who underwent this procedure and had follow-up of at least 6 months. Operative time averaged 140 minutes, and blood loss averaged 660 ml; 22% of the patients required a transfusion. Average postoperative hospitalization was 5 days. Two patients required a temporary colostomy for unrecognized rectal injury, and 2 developed a stricture requiring more than one dilation. Three patients (6%) wear pads for mild stress incontinence. One patient died of a cerebral vascular accident.