Radical prostatectomy for stage B2 prostatic cancer

It has been suggested that patients with large, localized prostatic carcinomas (stage B2) may not be good candidates for radical prostatectomy. Inaccuracy of the rectal examination is a particular problem with a lesion of this type. Unrecognized extension beyond the prostatic capsule, especially into the seminal vesicles, is well known and unsuspected involvement of pelvic lymph nodes may be present. Patients with clinical stage B2 prostatic carcinoma who seemed to be potentially good candidates for radical prostatectomy have been subjected to pelvic lymphadenectomy for staging. All of these patients have a normal chest x-ray, serum acid phosphatase, excretory urogram and radioisotope bone scan. During a 101/2-year interval 87 patients with clinical stage B2 prostatic carcinoma underwent staging pelvic lymphadenectomy. Of these patients 24 (28 per cent) had positive pelvic lymph nodes and were excluded from consideration for radical prostatectomy. Fifty patients with clinical stage B2 prostatic carcinoma and proved negative pelvic lymph nodes have been subjected to radical prostatectomy: 43 (86 per cent) had tumor confined to the prostate on histologic examination of the radical prostatectomy specimen, 6 (12 per cent) had microscopic capsular invasion and 2 (4 per cent) had microscopic invasion of the seminal vesicles. Radical prostatectomy seems justified when there is a high likelihood that the tumor truly is confined to the substance of the prostate. In our experience pelvic lymphadenectomy has enabled us to select appropriate patients with stage B2 prostatic carcinoma for radical prostatectomy.