Contemporary results of anatomic radical prostatectomy

William J. Catalona*, Christian G. Ramos, Gustavo F. Carvalhal

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

99 Scopus citations


With current clinical practice, most newly diagnosed cases of prostate cancer are potentially life-threatening yet still curable. The anatomical (nerve-sparing) radical prostatectomy has dramatically improved the results of surgical treatment. Other new management options, including conformal (three-dimensional) external beam radiation therapy, radioactive seed implantation (brachytherapy), cryoablation, and hormonal therapy, may be useful in some patients, but they are all probably less effective than radical prostatectomy. Suitability for radical prostatectomy generally requires a clinically localized, potentially life-threatening tumor [as defined by Gleason grade, tumor stage, and serum prostate-specific antigen (PSA) level], a life expectancy of 10 years, and no serious co-morbid medical conditions. With contemporary radical prostatectomy, about 70% of men with clinically localized disease will be cured, depending on tumor grade, tumor stage, and the serum PSA level. Urinary continence and sexual potency can be preserved in most patients, but substantially better results have been reported from centers of excellence than from community-based series. Other complications occur in about 10% of patients and with greater frequency in older patients. The operative mortality rate is less than 0.5%. Neoadjuvant hormonal therapy does not appear to affect treatment failure rates in patients undergoing radical prostatectomy. Prostatectomy may be beneficial in patients with microscopic lymph node metastases. Postoperative adjuvant radiotherapy may also be beneficial for patients with adverse pathologic findings. Salvage radical prostatectomy after radiation failure is associated with a 10-fold higher risk of complications and limited prospects for cure. Prospective, randomized clinical trials are underway to compare the results of radical prostatectomy with other treatments. Currently, radical prostatectomy is considered the preferred treatment for men with localized disease and a 10-year life expectancy.

Original languageEnglish (US)
Pages (from-to)282-296
Number of pages15
JournalCa-A Cancer Journal for Clinicians
Issue number5
StatePublished - 1999

ASJC Scopus subject areas

  • Hematology
  • Oncology


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