Perineal versus retropubic radical prostatectomy for T1, T2 prostate cancer

To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate.

From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52-74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (T1a 17% vs 25%, T2 82% vs 74%), mean and median pre-operative prostate-specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n < 2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed; operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively.

Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ-confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin-positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients; 11 and 3% of the patients were potent 3-6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups.

When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.