NEW INDICATIONS FOR RADICAL PROSTATECTOMY

Purpose: Radical prostatectomy is considered the gold standard for tre atment of localized prostate cancer, either as primary or salvage ther apy. Recently with the advent of increased organ transplantation, use of prostatic specific antigen for cancer detection and cryoablation as an alternative treatment, more men with prostate cancer can be consid ered for radical surgery. We review these new indications. Materials a nd Methods: Clinically localized untreated prostate cancers were ident ified in 3 men being considered for cardiac or lung transplantation (g roup 1), and 4 men originally treated with transperineal cryoablation had local relapse (group 2). All 7 men underwent radical prostatectomy . Results: Organ confined cancer (pT2C) was found in all 3 patients in group 1. All 3 men underwent successful cardiac or lung transplantati on 1 to 12 months after radical prostatectomy, and they are disease-fr ee at short-term followup. Of the group 2 patients 2 had organ confine d disease (pT2b and c) and 2 had extensive extraprostatic disease (pT3 cN1 and pT3cN0). Only 2 patients remain disease-free and do not requir e adjuvant endocrine therapy. Major perioperative complications of rec totomy and total incontinence occurred only in group 2 patients. Concl usions: Patients being considered for heart and lung transplantation n eed to be free of concurrent malignancy because of immunosuppressive t herapy. Radical prostatectomy can achieve this goal in select patients . Cases of failed cryoablation can be salvaged with radical prostatect omy but with less chance of success and with greater risk of complicat ions.