Benefits and drawbacks of specific approaches
Radical prostatectomy
Anatomic radical prostatectomy, as described by Walsh, et al, defines the standard approach to the management of localized prostate cancer, due to its published efficacy with long-term follow-up (1). In addition to its cancer curative potential, anatomic prostatectomy has a reasonable quality of life outcome, with full return of urinary continence representing the norm (3). In young men with early stage lesions, where bilateral nerve sparing is possible, sexual potency preservation with this method is likely (5). Laparoscopic, robotically-assisted radical prostatectomy may have additional advantages, including better identification of the neurovascular bundles and dorsal venous plexus vasculature through direct visualization, potentially leading to less blood loss and better potency preservation compared with the classic technique (4), though the benefit of laparoscopic, robotically assisted radical prostatectomy relative to classic radical prostatectomy has not been proven in any scientifically rigorous head to head comparison.
Radical prostatectomy also has potential drawbacks, including all the risks that go with a major operation, as well as the need for hospitalization, need for a urinary catheter for several weeks following the procedure, and
a recovery period that may take months to complete. Potency preservation is not guaranteed, particularly for patients with non-favorable tumor presentations, where sacrifice of one or both neurovascular bundles may still be required to adequately remove all of the tumor. Older patients also have lower potency preservation rates,
even if both neurovascular bundles are spared (5). The laparoscopic robotically-assisted prostatectomy method has a substantial learning curve and expertise in its application remains rare (6).
|
