Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at University of Gothenburg, Bruna Stråket 11 B, Göteborg, Sweden.
Acta Oncol. 2011 Jun;50 Suppl 1:92-7. doi: 10.3109/0284186X.2010.535848.
Radical prostatectomy (RP) is worldwide probably the most common procedure to treat localized prostate cancer (PC). Due to a more widespread use of Prostate-Specific Antigen (PSA) testing, patients operated today are often younger and have organ confined disease justifying a more preservative surgery. At the same time, surgical technique has improved resulting in lower risk of permanent side-effects. This paper aims to give an overview of results from modern surgery regarding cancer control and side-effects. A brief overview of the history is given.
A literature research identified recently published papers focusing on outcome and side-effects after RP.
One large randomized study (SPCG-4) compared RP and watchful waiting (WW). The study showed that RP was superior to WW in preventing local progression (RR = 0.36), distant metastasis (RR = 0.65) and death from PC (RR = 0.65). Observational studies also show a better outcome for men treated with RP compared to WW. Peri-operative mortality after RP is low in most material around 0.1%. The risk of stricture of the vesico-urethral anastomosis has decreased with improved technique from historically 10-20% to a low incidence of around 2-9% today. Also the risk of incontinence has declined with improved technique. However, while the rates of severe incontinence is usually very low, as many as 30% still report light incontinence after long-term follow-up. Erectile dysfunction (ED) is still a frequent side-effect after RP. This risk is dependent on age, pre-operative sexual function, surgical technique and other risk factors for ED such as smoking, diabetes, etc. In selected subgroups the risk of ED is low. Inguinal hernia is a more recently described complication after open retropubic RP with a postoperative incidence of 15-20% within three years of surgery.
RP is an effective method to achieve cancer control in selected patients. With modern technique it is a safe procedure with a low risk of permanent side-effects except for ED.
根治性前列腺切除术（RP）是目前全球范围内治疗局限性前列腺癌（PC）最常用的方法。由于前列腺特异性抗原（PSA）检测的广泛应用，今天接受手术的患者通常更年轻，且患有器官局限性疾病，这使得手术更具保留性。与此同时，手术技术也得到了改进，从而降低了永久性副作用的风险。本文旨在概述现代手术在癌症控制和副作用方面的结果。本文简要回顾了前列腺切除术的历史。
文献检索确定了最近发表的重点关注 RP 术后结果和副作用的论文。
一项大型随机研究（SPCG-4）比较了 RP 和观察等待（WW）。该研究表明，RP 在预防局部进展（RR=0.36）、远处转移（RR=0.65）和 PC 死亡（RR=0.65）方面优于 WW。观察性研究也表明，接受 RP 治疗的男性比 WW 治疗的男性有更好的结果。RP 术后围手术期死亡率在大多数研究中较低，约为 0.1%。随着技术的改进，吻合口狭窄的风险已从历史上的 10-20%降低到今天的低发生率（约 2-9%）。同时，控尿功能也得到了改善。然而，虽然严重尿失禁的发生率通常非常低，但仍有多达 30%的患者在长期随访后报告有轻度尿失禁。勃起功能障碍（ED）仍然是 RP 后的常见副作用。这种风险取决于年龄、术前性功能、手术技术和其他 ED 的危险因素，如吸烟、糖尿病等。在某些亚组中，ED 的风险较低。腹股沟疝是开放耻骨后 RP 术后较新描述的并发症，术后三年内的发病率为 15-20%。
RP 是一种治疗局限性前列腺癌的有效方法。采用现代技术，它是一种安全的手术，除 ED 外，永久性副作用的风险较低。
