Open Access Technical innovations

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

Eijiro Okajima1*, Motokiyo Yoshikawa1, Yasumasa Masuda1, Kazuhiro Shimizu2, Nobumichi Tanaka3, Akihide Hirayama3, Keiji Shimada4, Kiyohide Fujimoto3 and Yoshihiko Hirao3

Author Affiliations

1 Department of Urology, Nara City Hospital, Eijiro Okajima Higasikidera-cho 1-50-1, Nara, Nara, 630-8305, Japan

2 Kashiwai Clinic, Eijiro Okajima Higasikidera-cho 1-50-1, Nara, Nara, 630-8305, Japan

3 Department of Urology, Nara Medical University, Eijiro Okajima Higasikidera-cho 1-50-1, Nara, Nara, 630-8305, Japan

4 Department of Pathology, Nara Medical University, Eijiro Okajima Higasikidera-cho 1-50-1, Nara, Nara, 630-8305, Japan

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World Journal of Surgical Oncology 2012, 10:249  doi:10.1186/1477-7819-10-249

Published: 16 November 2012

Abstract

Background

Retropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer.

Methods

A total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naïve prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR).

Results

The surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2).

Conclusions

RRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.

Keywords:
Prostate; Neoplasms; Prostatectomy