A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group

Objective To review and compare the outcome of patients undergoing radical retropubic prostatectomy (RRP) or radical perineal prostatectomy (RPP) for clinically localized prostate cancer, Patients and methods From 1988 to 1997, 1382 men who were treated by RRP an d 316 by RPP were identified from databases of the Uniformed Services Urolo gy Research Group. The following variables were assessed; age, race, prosta te-specific antigen (PSA) level before surgery, clinical stage, biopsy Glea son sum, estimated blood loss (EBL), margin-positive rate, pathological sta ge, biochemical recurrence rate, short and long-term complication rates, im potence and incontinence rates. To eliminate selection bias, the analysis w as concentrated on pairs of patients matched by race, preoperative PSA leve l, clinical stage and biopsy Gleason sum. Results In the 190 matched patients there were no significant differences b etween the RRP and RPP groups in either organ-confined (57% vs 55%), margin -positive (39% vs 43%), or biochemical recurrence rates (12.9% vs 17.6% at a mean followup of 47.1 vs 42.9 months), respectively. The mean EEL was 157 5 mi, in the RRP group and 802 mt in the RPP group (P < 0.001). The only si gnificant difference in complication rates was a higher incidence of rectal injury in the RPP group (4.9%) than in the RRP group (none, P < 0.05). Conclusions In similar populations of patients, RPP offers equivalent organ -confirmed, margin-positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.