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Commentary RE: Radical Prostatectomy: Long-Term Results on Cancer Control, Survival and Trifecta (Freedom from PSA, Continence, and Potency) Probabilities

      Radical prostatectomy is 1 of the more complex operations performed in urology. Optimal outcomes clearly depend on fine details in surgical technique.
      • Vickers AJ
      • Bianco FJ
      • Serio AM
      • et al.
      The surgical learning curve for prostate cancer control after radical prostatectomy.
      ,
      • Bianco Jr, FJ
      • Vickers AJ
      • Cronin AM
      • et al.
      Variations among experienced surgeons in cancer control after open radical prostatectomy.
      The goals of the operation are to remove the entire cancer with negative surgical margins and with complete recovery of urinary continence and erectile function. While better understanding of periprostatic anatomy has improved outcomes, no surgeon has yet achieved perfect outcomes in every patient. Wide dissection around the prostate may provide optimal cancer control, but would likely reduce the chances of recovery of continence and potency. Alternatively, an operation designed to maximize quality of life outcomes would likely have inferior oncologic outcomes. This defines the continuing challenge of radical prostatectomy: designing and performing a safe operation for an individual patient with cancer that optimizes cancer control while preserving urinary and erectile function.
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      References

        • Vickers AJ
        • Bianco FJ
        • Serio AM
        • et al.
        The surgical learning curve for prostate cancer control after radical prostatectomy.
        J Natl Cancer Inst. 2007; 99: 1171-1177
        • Bianco Jr, FJ
        • Vickers AJ
        • Cronin AM
        • et al.
        Variations among experienced surgeons in cancer control after open radical prostatectomy.
        J Urol. 2010; 183: 977-982
        • Bianco Jr, FJ
        • Scardino PT
        • Eastham JA
        Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”).
        Urology. 2005; 66: 83-94
        • Begg CB
        • Riedel ER
        • Bach PB
        • et al.
        Variations in morbidity after radical prostatectomy.
        N Engl J Med. 2002; 346: 1138-1144

      Linked Article

      • Radical prostatectomy: Long-term cancer control and recovery of sexual and urinary function (“trifecta”)
        UrologyVol. 66Issue 5
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          Radical prostatectomy (RP) disrupts the natural history of prostate cancer. However, it could be a significant source of long-term incontinence and potency morbidity. We studied the long-term cancer survival results and the probabilities of achieving ideal “trifecta” outcomes (cancer control, continence, and potency) after this surgical procedure. A total of 1746 intervention-naive patients with clinically localized newly diagnosed prostate cancer underwent RP with curative intent beginning in 1983.
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