Radical retropubic prostatectomy for localised prostatic carcinoma: a clinical and pathological study of 201 cases

To examine the role of radical retropubic prostatectomy in clinically localised prostatic cancer we reviewed a series of 201 patients all of whom had undergone bilateral pelvic lymphadenectomy. Frozen section showed metastatic pelvic lymph nodes in 13 cases and 6 cases were too locally advanced for operation; prostatectomy was done for the remaining 182. The pathological staging was based on examination of sections of the whole organ. In 109 (60%) the carcinoma was confined to the prostate gland or to the specimen, in 46 (25%) there was carcinomatous growth in the surgical margin, and in 27 (15%) there was invasion of the seminal vesicles. The Gleason score was significantly higher in cases with involvement of the surgical margin or seminal vesicles. There was one operative death (of pulmonary embolism), and the postoperative cardiovascular morbidity was 7%. The incidence of wound infection was 6%, and there were two rectal injuries and three symptomatic lymphoceles. A total of 135/170 evaluable patients (79%) were completely continent postoperatively, and only two developed severe incontinence. Erectile potency was preserved in 24 of 126 (19%). We conclude that radical retropubic prostatectomy is safe and that the complication rate is acceptable. The completeness of the tumour excision seems to be associated with the pathological grade of the tumour.