Radical prostatectomy in the treatment of prostate cancer. The experience of the Urology Clinic of „Prof. Dr. Th. Burghele” Clinical Hospital

Introduction: radical prostatectomy remains a real challenge for most of the urologists. Our study’s objective is bringing into discussion the main aspects related to the technique we use, the intra and post-operatory complications, as well as the short-term analysis of the results in PC treatment using RP in the „Prof. Dr. Th. Burghele” Clinical Hospital - Clinic of Urology. Material and methods: between 1999 and 2007, 59 patients with PC, aged 48-74, were operated in our clinic. We began to recommend prostate biopsy (PB) to all patients with PSA higher than 4 ng/ml and, in the last years, higher than 2,5 ng/ml. A change in our attitude is related to the PB. At the beginning, we tried to perform „targeted” punctions, ultrasound guided especially in suspect zones, afterwards, we performed randomised punctions at all the patients, no matter the aspect of TRUS and we have increased the number of punctions accordingly to the prostate volume (minimum 6 punctions, maximum 12). The most used was the 10 core punction. The T classification, according to the clinical diagnosis, of the 59 operated patients: T1 cT1 a-b - 4 cases; cT1 c - 39 cases;T2 cT2 a - 12 cases; cT2 b - c - 4 cases. The RP surgical technique was the classic one, described by P.C. Walsh – the first surgical step, in all cases was lymphadenectomy. Results: of all the patients that went through RP, 56 cases are still in our records. We can consider healed 24 patients with PC, followed for 3 years post-surgery, because they had no need of therapy and the PSA is maintained below 0.02 ng / ml. The Gleason score - between the pre-operatory established diagnosis by punction and the anatomic-pathological examination of the piece, there were some differences: the concordance was in 48% of the cases; in 39% of the patients, the biopsy specimen had a lower Gleason score than the surgery specimen, and in 13 % a higher score, the most common error was caused by sampling. The correlation between the pre-operatory evaluated clinical stage and the pathological clinical stage was of 57%. The most important late postoperative complications of RP were: urinary incontinence and erectile dysfunction. In our study, we have recorded late postoperative: complete urinary incontinence in 4 cases (6.7%), erection was maintained after bilateral preservation of neurovascular bandelets in 90% of cases and after unilateral preservation in 71% of cases. Due to the short following period, we can’t say if the operated patients by us had a benefit regarding the general surviving period; The personalized interpretation of the increase of serum PSA levels after surgery represents a possible problem regarding the indication of complementary treatment.