RADICAL RETROPUBIC PROSTATECTOMY FOR LOCALIZED CARCINOMA OF THE PROSTATE IN A LARGE METROPOLITAN HOSPITAL - CHANGING TRENDS OVER A 10-YEAR PERIOD (1984-1994)

Objectives. To analyze changing trends in the surgical treatment for l ocalized carcinoma of the prostate in a large metropolitan community h ospital over a 10-year period from 1984 to 1994. Methods. The records of all 428 patients who underwent radical prostatectomy for localized carcinoma of the prostate from January 1, 1984, to January 1, 1994, at a large metropolitan community hospital (Baylor University Medical Ce nter, Dallas, Tex) were retrieved and data abstracted in a predefined computerized database by a urology resident who was not part of the pa tient's surgical team. The abstracted data included attending surgeon, date of surgery, patient's age, clinical stage at presentation and pa thologic stage, prostate-specific antigen (PSA), perioperative events, such as duration of surgery, blood loss, transfusion, duration of hos pital stay, comorbidities according to the Charlson comorbidity index, and others. The data were analyzed in regard to changes over the 10-y ear period and stratified by a variety of parameters. Results. The num ber of radical prostatectomies performed increased by fourfold from 19 84 to 1995. The distribution of clinical stage and the incidence of pa thologic upstaging noted in the 428 cases were similar to other series reported in the literature. The average age of patients decreased fro m 67 to 63 years over the 10 years (average calculated in increments o f 15 cases in ascending order). Similarly, over time the average durat ion of surgery, average blood loss, average use of transfusion, and th e average duration of hospital stay decreased. When the cases were gro uped by individual attending surgeon, whose numerical surgical experie nce during that time period ranged from 1 to 76 cases, no correlation was noted between the numerical experience and these outcomes. Conclus ions. As opposed to the national Medicare experience recently reported by the Prostate Patients Outcome Research Team, the increase in the n umber of cases performed was mostly due to patients under the age of 7 0 years, considered reasonable candidates for radical prostatectomy. I ndependent of numerical experience of individual attending surgeons, d uration of surgery, blood loss, transfusion rates, and duration of hos pital stay decreased during this period. This might indicate a learnin g effect due to continuing education, exchange of ideas, published tec hnical improvements in the surgical procedure, and other factors, ulti mately benefiting the patient by improving outcomes.