Radical perineal prostatectomy for palpable, clinically localized, non-obstructive cancer: experience at the Johns Hopkins Hospital 1909-1963.

Of 447 patients who underwent radical perineal prostatectomy and were examined during the 54 years of study only those with a 1 to 2 cm. nodule within an otherwise clinically normal prostate have, on the average, done well. When the current staging segregation has been used, these cases were labeled B1 or occasionally B1n, and were nearly always grade 1 or 2, although 77 per cent were diffuse microscopically within the gland. No patient with a grade 3 cancer has lived 15 years free of disease. Biopsy is mandatory for diagnosis and for eliminating grade 3 cancer. The immunochemical determination of prostatic acid phosphatase in the bone marrow, not used in these reported cases, may prove to be the most sensitive test for otherwise unrecognized osseous metastases. So far no non-invasive test is infallible in detecting micrometastases in lymph nodes but these are rare when the tumor is a 1 to 2 cm. nodule. In such cases the operation, so far, provides a 15-year survivorship better than that of any other modality.