Changing indications and histological and laboratory results of radical prostatectomy.

Objectives : To compare : 1) the incidence of positive resection margins af ter radical prostatectomy, 2) the incidence of secondary elevation of PSA, in two groups of patients operated before and after May 1994. Methods : We collected and compared preoperative (PSA, Gleason score on bio psies, positive apical biopsies) and postoperative variables (number and si te of positive margins, secondary elevation of PSA) in two historical cohor ts of 115 and 67 patients undergoing retropubic radical prostatectomy. Results : We currently operate on tumours characterized by lower PSA values with a smaller proportion of positive apical biopsies. Inversely the propo rtion of high Gleason scores appears to be greater although the difference is not statistically significant. The decreased incidence of positive resection margins and PSA failure rate compared to our initial series reflects the improvement of the oncological results. The respective place of improvement of techniques and changing ind ications has yet to be defined Conclusion : This study demonstrates the changing operative indications and histological and laboratory results over time. The documented improvement of oncological results is partly related to the progress in surgical indica tions.