5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer

The new anatomical approach to radical retropubic prostatectomy with its nerve sparing option allows for preservation of erections, improved urinary continence, decreased blood loss, and lower operative mortality and morbidity rates. We sought to evaluate cancer control with this operation by determining the 5-year tumor recurrence rates using detectable serum prostate specific antigen levels as a criterion for tumor recurrence in a series of 925 consecutive men with clinical stage T1 or T2 prostate cancer. Overall, the 5-year probability of nonprogression was 78% (95% confidence limits 74 to 82%). The 5-year nonprogression rate was higher in patients whose tumors were not palpable (90% for impalpable tumors detected through transurethral resection of the prostate, 97% for impalpable prostate specific antigen detected tumors and 74% for palpable tumors). Nonprogression correlated with pathological tumor stage (91% for organ confined disease, 74% for positive margins or microscopic capsular perforation, 32% for seminal vesical invasion and virtually nil for lymph node metastases) and tumor grade (89% for well, 78% for moderately and 51% for poorly differentiated tumors). We conclude that anatomical radical prostatectomy achieves excellent cancer control for patients with organ confined prostate cancer.