| Abstract: |
Radical prostatectomy (RP) is the mainstay of treatment for patients with clinically localized prostate cancer, especially for those patients with high-risk cancer. Large multi-institutional studies have documented excellent long-term outcomes in terms of biochemical recurrence rates and prostate cancer-specific mortality after RP. Proper preoperative planning begins with selecting patients who have potentially lethal cancers and are likely to benefit from surgery, and in whom RP is reasonably likely to remove the entire tumor. Magnetic resonance imaging (MRI) is used to delineate the anatomic details of the prostate and of the cancer, and can assist in customizing the operation, particularly in regard to nerve sparing. Oncologic and functional outcomes are highly dependent on surgical technique and on the surgeon’s level of experience. In our experience, early release of the neurovascular bundles, full preservation of urethral length, complete excision of the seminal vesicles, and wide dissection with careful reconstruction of the bladder neck are key components to optimal cancer control and recovery of sexual and urinary function. In this chapter, we provide a detailed description of our approach to retropubic RP. © Springer Science+Business Media New York 2014. |
