Long-term autopsy findings following radical prostatectomy

In reviewing the Johns Hopkins Hospital records of over 1,000 radical prostatectomies performed since 1904, only 10 men have had a subsequent autopsy. All were managed by radical perineal prostatectomy without adjunctive therapy; 4 individuals had pathologic Stage B disease, and 6 men had pathologic Stage C cancer. The mean time interval between surgery and death was 8.9 years and 8.8 years for pathologic Stages B and C patients, respectively. Four patients (2 pathologic Stage B and 2 pathologic Stage C) had no evidence of disease, either local or distant, at autopsy. Two men (1 pathologic Stage B and 1 pathologic Stage C) had only microscopic foci of local recurrence without distant metastases. Four other patients (1 pathologic Stage B and 3 pathologic Stage C) had bulky distant metastases; of these, 1 had no local disease, and 3 patients had only microscopic recurrence in the pelvis. No patient had gross pelvic recurrence, and no individual with microscopic local disease had symptoms secondary to that recurrence. Four patients (1 pathologic Stage B and 3 pathologic Stage C) died of prostatic cancer secondary to distant metastases. These data suggest: radical prostatectomy alone provides excellent local control of the primary tumor, irrespective of the pathologic stage; in patients where bulky metastatic disease was responsible for death, distant dissemination may have occurred prior to radical prostatectomy since all patients had either no pelvic disease or only microscopic local recurrence.