TY - JOUR
T1 - A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes
AU - Boorjian, Stephen A.
AU - Eastham, James A.
AU - Graefen, Markus
AU - Guillonneau, Bertrand
AU - Karnes, R. Jeffrey
AU - Moul, Judd W.
AU - Schaeffer, Edward M.
AU - Stief, Christian
AU - Zorn, Kevin C.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/4
Y1 - 2012/4
N2 - Context: The optimal management strategy for men with newly diagnosed clinically localized prostate cancer remains a matter of debate. Numerous series have reported cancer control and quality-of-life (QoL) outcomes following treatment with radical prostatectomy (RP). Objective: Critically review published oncologic and functional outcomes after RP, and evaluate factors associated with these outcome measures. Evidence acquisition: A review of the literature was performed using the Medline and Web of Sciences databases. Relevant reports published between 1980 and 2011 identified using the keywords prostate cancer, radical prostatectomy, prostate-specific antigen, biochemical recurrence, incontinence, and erectile dysfunction were reviewed and summarized. Evidence synthesis: Cancer control rates following RP largely depend on the definition of treatment efficacy. While up to 40% of men have been reported to experience postoperative biochemical recurrence on long-term follow-up, death from prostate cancer has been noted in <10% of men at 15 yr after surgery in contemporary series. For men with high-risk disease, surgery affords pathologic staging, thereby facilitating the selective application of secondary therapies, and has been associated with decreased mortality risk versus radiation in retrospective series. Reported functional outcomes after surgery, particularly urinary continence and erectile dysfunction, have varied greatly to date. These assessments have been limited by nonstandardized reporting methodology. The use of robot-assisted radical prostatectomy has increased in recent years, and while follow-up is thus far short, available data do not suggest the superiority of either approach in terms of functional or oncologic outcomes. Conclusions: RP is associated with excellent long-term cancer control. Continued efforts to conduct prospective assessments of postoperative functional outcomes are necessary using validated QoL instruments. The importance of surgical approach will also require further study, incorporating comparative oncologic, functional, and economic data.
AB - Context: The optimal management strategy for men with newly diagnosed clinically localized prostate cancer remains a matter of debate. Numerous series have reported cancer control and quality-of-life (QoL) outcomes following treatment with radical prostatectomy (RP). Objective: Critically review published oncologic and functional outcomes after RP, and evaluate factors associated with these outcome measures. Evidence acquisition: A review of the literature was performed using the Medline and Web of Sciences databases. Relevant reports published between 1980 and 2011 identified using the keywords prostate cancer, radical prostatectomy, prostate-specific antigen, biochemical recurrence, incontinence, and erectile dysfunction were reviewed and summarized. Evidence synthesis: Cancer control rates following RP largely depend on the definition of treatment efficacy. While up to 40% of men have been reported to experience postoperative biochemical recurrence on long-term follow-up, death from prostate cancer has been noted in <10% of men at 15 yr after surgery in contemporary series. For men with high-risk disease, surgery affords pathologic staging, thereby facilitating the selective application of secondary therapies, and has been associated with decreased mortality risk versus radiation in retrospective series. Reported functional outcomes after surgery, particularly urinary continence and erectile dysfunction, have varied greatly to date. These assessments have been limited by nonstandardized reporting methodology. The use of robot-assisted radical prostatectomy has increased in recent years, and while follow-up is thus far short, available data do not suggest the superiority of either approach in terms of functional or oncologic outcomes. Conclusions: RP is associated with excellent long-term cancer control. Continued efforts to conduct prospective assessments of postoperative functional outcomes are necessary using validated QoL instruments. The importance of surgical approach will also require further study, incorporating comparative oncologic, functional, and economic data.
KW - Biochemical recurrence
KW - Erectile dysfunction
KW - Incontinence
KW - Prostate cancer
KW - Prostate-specific antigen
KW - Radical prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=84857658304&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857658304&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2011.11.053
DO - 10.1016/j.eururo.2011.11.053
M3 - Review article
C2 - 22169079
AN - SCOPUS:84857658304
SN - 0302-2838
VL - 61
SP - 664
EP - 675
JO - European urology
JF - European urology
IS - 4
ER -