LONG-TERM RESULTS OF RADICAL PERINEAL PROSTATECTOMY

The cancer-specific death rate following radical prostatectomy in pati ents with organ-confined and specimen-confined disease is 10% at 13.5 years, less than the noncancer death rate of 20% for patients in these disease extent categories. The median age of all patients in these ca tegories was 65 years. Cancer remains the dominate cause of death in p atients with margin-positive disease, being 40% at 13.5 years. Disease detected by prostate-specific antigen (PSA) rather than digital recta l examination appears to be of smaller volume and to have a higher pro bability of being margin negative. Data indicate that early detection by PSA will shift patients to a more favorable disease category at the time of surgical intervention. Disease recurrence or persistence by P SA detection seems to precede clinical detection of disease by 3-5 yea rs. Disease recurrence by PSA detection does not predict survival outc ome, probably does not differentiate between local and distant microsc opic recurrence and is not predictive of biological aggressiveness.