Complications of Open Radical Retropubic Prostatectomy in Potential Candidates for Active Monitoring

Objectives: With the widespread use of prostate-specific antigen (PSA)-based screening, there is now concern about the overdiagnosis and overtreatment of men with low-risk prostate cancer (PCa). One of the most difficult aspects of PCa management is a balance of the often-competing goals of cancer control with functional outcomes and quality of life. To address this issue, we examined the potency, continence and overall complication rates associated with radical prostatectomy (RP), specifically in potential candidates for active monitoring. Methods: From a large RP database, we compared potency, continence, and complication rates among men meeting one of the following active monitoring criteria from the literature: clinically localized, Gleason score of 7 or less, and no significant comorbidities; T1b-T2b NOMO, Gleason score of 7 or less, and PSA of 15 ng/mL or less; and T1c PCa. Results: There were 3458, 3533, and 2338 men who met the above criteria, respectively. After 18 months of follow-up, potency was preserved in 70% to 74%. At least 93% of patients were continent, and the rate of surgical complications ranged from 5% to 7%. Increasing age was significantly associated with a greater risk of all complications. Conclusions: Men with newly diagnosed low-risk PCa must carefully weigh the risks and benefits of treatment. In young men with low-risk PCa, RP was associated with a relatively low complication rate and good long-term functional outcomes. However, with increasing age, RP was associated with significantly higher complication rates. These results can be used to help guide management decisions for men with low-risk disease.