gms | German Medical Science

Introduction: Based on validated preoperative nomograms the presence of locally advanced PCA can be predicted with a high accuracy. If radical surgery is considered as therapeutic option, radical retropubic prostatectomy (RPE) requires an individualized surgical technique to reduce positive surgical margins and to detect occult micrometastatic pelvic lymph node disease. We report on our experience with an extended RPE combined with extended pelvic lymph node dissection (epLA) compared to a matched control group of men undergoing classical RPE.

Patients & Methods: 112 consecutive patients with histologically proven PCA and preoperative prediction of locally advanced disease based on the Kattan nomograms underwent extended RPE and epLA: the membraneous urethra is dissected approx. 3-4mm distally to the apex without intraprostatic preparation, dorsolateral resection includes wide resection of the neuroascular bundle including the lateral endopelvic fascia and the perirectal fat, Denonvillier’s fascia is only opened at the tip of the seminal vesicles and the bladder neck is widely excised without a bladder sparing technique. EpLA included the resection of all lymph nodes in the obturator fossa, external, internal and common iliac area as described previously. Functional outcome, pathohistological findings, and complications were compared to a matched control group of 112 patients having undergone classical RPE with epLA.

Results: Both groups did not differ significantly in terms of preoperative PSA serum levels and distribution of pathohistological stage. Lymph node metastases were detected in 23% and 26% of patients having undergone eRPE or RPE, respectively. Positive urethral and vesical margins were identified in 36/112 (32%) and in 10/112 (9.8%) patients. Following eRRP positive urethral and vesical surgical margins were identified in 10/112 (8.9%) and in 4/112 (3.5%) cases (p < 0.01). We did not encounter significant differences with regard to patency of the vesicourethral anastomosis on postoperative day 4 (89% vs 85%) and early continence on postoperative day 5 (66% vs 69%). Due to the short follow-up period, no valid information can be given with regard to the oncological outcome in terms of biochemical recurrence and survival.