[Recent improvements and results of radical prostatectomy]

In Japan, the proportion of patients with localized prostate cancer treated by radical prostatectomy is increasing rapidly. The recent improvements and treatment results of radical prostatectomy were reviewed. As for the qualifications of patient candidates for radical surgery, including patient age, various clinical and pathological findings to predict tumor extent and disease-free outcome (clinical stage, serum prostate specific antigen, PSA density, number of positive biopsies, histological grade, etc) must be kept somewhat tidy. Recently, there has been increased interest in the application of preoperative hormone treatment for localized tumor group in order to improve radicality and survival. Several studies reported the results of neoadjuvant endocrine therapy. As for stage C tumors, the proportion of patients with capsular invasion, positive surgical margin, invasion of seminal vesicle and positive node metastasis are 67-86%, 39-64%, 32-47% and 38-50%, respectively. Prospective randomized studies should provide conclusive information on the potential benefits of this treatment modality. The new anatomical approach to radical retropubic prostatectomy with its nerve-sparing option assures preservation of erection. This procedure achieves excellent cancer control for patients with a definite organ-confined tumor, but it is difficult to diagnose a specimen-confined tumor preoperatively. There is limited information on cancer control with the nerve-sparing option. More time is needed to obtain information on the long-term outcome after radical prostatectomy.