ISSN: 1305-3876
Hakkında: Özel sayılar şeklinde yayınlanır.
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Surgical Therapy At Localized Prostate Cancer
Dr. Veli YALÇIN,a Dr. Burak ÖZKANa
aÜroloji AD, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, İSTANBUL
Prostate cancer is recognized as one of the principal medical problems facing the male population. Prostate cancer constitutes about %11 of all male cancers and %9 of all cancers deaths among men within the world. By the time of diagnosis, only %55 of tumors are clinically localized in the absence of an organized screening programme. Even in modern series, %30-45 of patients with clinically localized disease are found to have extracapsular extension at pathological staging. The main diagnostic tools used to look for evidence of prostate cancer include digital rectal examination (DRE), serum prostate-specific antigen (PSA) and transrectal ultrasonography (TRUS). Material and Pathological stage is the most useful parameter which defines the result of therapy at localized prostate cancer. The way of therapy at prostate cancer depends on various factors such as the clinical stage, quality of life, life expectancy and co-morbidity of the patient. In men with localized prostate cancer and a life expectancy of 10 years or more, the goal of management must be eradication of the disease. The standart surgical technique for the treatment of localized prostate cancer is radical prostatectomy. This procedure was applied at the beginning of the 20 th century by Young who used a perineal approach while Millin performed retropubic radical prostatectomy (RRP) for the first time in 1945. In 1982, Walsh and Danker described the anatomy of dorsal venous complex and the technical aspects of surgery needed to reduce blood loss dramatically and to spare the neurovascular bundlees, avoiding definitive erectile dysfunction.
Currently radical prostatectomy is the only treatment for localized prostate cancer that has indicated a cancer specific survival benefit when compared to conservative management in prospective randomized trials. Surgical experience has decreased the complication rates and improved cancer cure. The operation is associated with minimal intra-operative and postoperative morbidity in the hands of of an experienced urologist. The retropubic approach is more commonly performed as it enables simultaneously pelvic lymph node assessment to be caried out as an advantage over the perineal approach.
Radical prostatectomy should be reserved for prostate cancer patients who have a high probability of cure and who will live long enough to benefit from traetment. Surgery alone cures most men with organ confined disease or with well to moderately differentiated tumors which have perforated the prostate capsule to an extent where it is still possible to obtain clear surgical margins.
As a conclusion, radical prostatectomy is an efficient and safe treatment modality for localized prostate cancer. The procedure is routinely performed either retopubically or using a transperineal approach while at nowadays most centers have gained experience with laparoscopic radical prostatectomy and robotic radical prostatectomy.Keywords: Localized prostate cancer, radical prostatectomy, radical retropubic prostatectomy, radical perineal prostatectomy, laparoscopic radical prostatectomyTurkiye Klinikleri J Surg Med Sci 2005, 1(9):40-45
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