Surgery from a US perspective

Prostate screening has made it possible to detect organ confined prostate carcinoma in men with a life expectancy of 20 years and longer. These clinically significant malignancies may be successfully eradicated by means of anatomical dissection of the prostate, which minimizes both morbidity and mortality. In a retrospective series of patients with clinically localized prostate cancer who were treated with a radical retropubic prostatectomy and lymph node dissection, 5 and 10 year crude survival rates were 96% and 86%. Survival was compromised by penetration of tumour through the prostatic capsule, and even more significantly by involvement of the seminal vesicles. The use of prostate specific antigen (PSA) concentrations to monitor disease progression before any clinical manifestation revealed that disease free survival was less than previously reported. Patients diagnosed and treated more recently had longer disease free survival than the overall group mainly because of earlier detection with PSA, with consequent lower tumour volumes and stage. In addition, 92 +/- 3(SD)% patients with pathologically organ confined tumours, without capsular or seminal vesicle invasion, are clinically disease free with non-detectable PSA at 5 years. Our data therefore show that radical prostatectomy can cure patients with organ confined prostate cancer, with acceptable morbidity. Although the need for cure may be questioned in many patients, young patients with prostate cancer almost certainly benefit from eradication of the malignancy.