Radical prostatectomy involves the surgical removal of the entire prostate gland, the seminal vesicles and adjacent tissue,1 and sometimes also pelvic lymph nodes.2 The operation may be performed via the retropubic or perineal route, but is increasingly being performed laparoscopically, with or without robotic assistance.1
In clinically localised prostate cancer, radical prostatectomy offers a high chance of cure and reduces prostate cancer-specific mortality compared with watchful waiting.2,3 However, radical prostatectomy is a major procedure requiring hospitalisation and carries the risk of post-operative complications.2,4 The most common adverse events are urinary incontinence and erectile dysfunction.1 Urinary incontinence is extremely frequent immediately after surgery, but persists in only around 5–20% of patients.1,4 Erectile dysfunction is the most common side effect, but can be treated1 and sexual function may improve within 2 years of surgery.5 Nerve-sparing surgery may help to preserve sexual function6, but is recommended for men with low risk cancers.7 Therefore, radical prostatectomy is generally only offered to younger, fitter men without comorbidities8 who have low or intermediate risk disease and a life expectancy of >10 years.7 Recent data also indicate a role for radical prostatectomy in the multimodality management of locally advanced disease. Radical prostatectomy combined with adjuvant or salvage treatments may be beneficial in certain patients.9
References:
1. Kirby RS, Patel MI. Fast facts: prostate cancer (5th ed). Health Press Ltd: Oxford, 2008.
2. Wilt TJ, Thompson IM. Clinically localised prostate cancer. BMJ 2006;333:1102-6.
3. Bill-Axelson A, Holmberg L, Filén F, et al. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst 2008;100:1144-54.
4. Michaelson MD, Cotter SE, Gargollo PC, et al. Management of complications of prostate cancer treatment. CA Cancer J Clin 2008;58:196-213.
5. Ferrer M, Suárez JF, Guedea F, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72:421-32.
6. Quinlan DM, Epstein JI, Carter BS, et al. Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 1991;145:998-1002.
7. European Association of Urology. Guidelines on prostate cancer, 2010.
8. National Institute for Health and Clinical Excellence. Clinical guideline 58. Prostate cancer, February 2008.
9. Van Poppel H, Joniau S. An analysis of radical prostatectomy in advanced stage and high-grade prostate cancer. Eur Urol 2008;53:253-9.