Radical prostatectomy in stage A prostatic adenocarcinoma.
A total of 76 patients (18 with stage A1 and 58 with stage A2 cancer) underwent radical perineal prostatectomy. No perioperative deaths occurred and no patient suffered rectal injury or was incontinent postoperatively. Five patients (3 with stage A1 and 2 with stage A2 disease) had negative surgical specimens, while 6 (4 with stage A1 and 2 with stage A2 cancer) had a single microscopic focus in the radical prostatectomy specimen. Outcome was assessed by first evidence of disease recurrence as a function of the Gleason sum and the local anatomical extent of disease. Of 41 patients 4 (9.7 per cent) with organ-confined disease failed at 2.5, 2.6, 4.3 and 11.9 years. None of 11 patients with specimen-confined disease failed, and 6 of 24 (25 per cent) with positive margins failed at 0.9, 1.2, 2.1, 3.1, 3.2 and 8.0 years. Radiation after an operation for margin-positive disease did not seem to alter the incidence of failure. The distribution frequency of the Gleason sum was noted to shift to a higher total sum as the extent of local disease increased. Kaplan-Meier analysis of the failure rate of patients with organ-confined and organ-nonconfined disease with a Gleason sum of 7 or less versus greater than 7 demonstrated an advantage for those with a sum of 7 or less (p less than or equal to 0.018).
Paulson, DF; Robertson, JE; Daubert, LM; Walther, PJ
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