Achieving optimal outcomes after radical prostatectomy Journal Article

Authors: Saranchuk, J. W.; Kattan, M. W.; Elkin, E.; Touijer, K.; Scardino, P. T.; Eastham, J. A.
Article Title: Achieving optimal outcomes after radical prostatectomy
Abstract: Purpose: The most favorable outcome that can be achieved after radical prostatectomy is complete tumor resection without recurrence and full recovery of continence and potency. Risks of erectile dysfunction, incontinence, and disease recurrence are well described, but in isolation, do not adequately inform patients of the possibility of becoming cancer-free while at the same time returning to their preoperative functional state. We sought to determine the frequency of optimal outcomes after radical prostatectomy and the time to such outcomes. Patients and Methods: Patients who underwent radical prostatectomy performed at a tertiary referral center between July 1998 and July 2003 for clinical stage T1 to T3 prostate cancer were identified. Patients were excluded if they were incontinent or impotent preoperatively, or if they had received radiotherapy or neoadjuvant androgen deprivation therapy previously. Six hundred forty-seven patients were analyzed for time to recovery of full continence and potency without cancer recurrence after surgery. Optimal outcome probability was calculated with a Markov state transition model to simulate clinical outcomes in the first 4 years following radical prostatectomy. Results: Mean patient age was 58 years, and mean pretreatment prostate-specific antigen was 6.9 ng/mL Cancer-free status with full continence and potency was achieved in 30% of men at 12 months, 42% at 24 months, 47% at 36 months, and 53% at 48 months postoperatively. Conclusion: Optimal outcomes after radical prostatectomy can be achieved in a small majority of cases. Time to full recovery is primarily dictated by recovery of erectile function. This information is helpful for patients interested in their chances of returning to their preoperative functional state. © 2005 by American Society of Clinical Oncology.
Keywords: adult; controlled study; treatment outcome; aged; disease-free survival; middle aged; major clinical study; cancer recurrence; postoperative period; patient selection; cancer radiotherapy; disease free survival; cancer staging; neoplasm staging; prostate specific antigen; markov chains; pathology; mathematical model; prostate cancer; simulation; prostate-specific antigen; prostatic neoplasms; blood; preoperative period; probability; urine incontinence; prostatectomy; adjuvant chemotherapy; prostate tumor; tertiary health care; antiandrogen; convalescence; urinary incontinence; impotence; penis erection; stress incontinence
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 18
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-06-20
Start Page: 4146
End Page: 4151
Language: English
DOI: 10.1200/jco.2005.12.922
PUBMED: 15961762
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 62" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Peter T Scardino
    621 Scardino
  2. Elena B Elkin
    149 Elkin
  3. Abdelkrim Karim Touijer
    190 Touijer
  4. James Eastham
    426 Eastham
  5. Michael W Kattan
    218 Kattan