Clinical results of radical prostatectomy for patients with prostate cancer in Macau.

BACKGROUND: Incidence of prostate cancer has been increasing in recent decades. In the year 2005, prostate cancer became the second most common cancer in males in Macau. The purpose of this report was to review and summarize the clinical features and prognosis of the 54 patients undergoing radical prostatectomy in Macau Special Administrative Region (SAR), China. METHODS: From November 2000 to November 2006, retropubic radical prostatectomy were performed in 54 cases for the treatment of prostate cancer. The mean age of patients was 69.8 years (range from 54 to 79). The preoperative prostate specific antigen (PSA) level, postoperative pathologic stage and Gleason's score, operation duration, intraoperative bleeding and intraoperative and postoperative complications were reported. The follow-up duration was 3 months to 6.25 years with a mean of 2.1 years. Postoperative parameters including PSA alteration, biochemical recurrence, local recurrence, distant metastasis and mortality were observed. RESULTS: Most of the patients in our study were diagnosed as localized prostate cancer. The patients' preoperative serum PSA was 0-4.0 ng/ml (16.7%), 4.0-10.0 ng/ml (51.8%), 10.1-20.0 ng/ml (24.1%) and above 20.0 ng/ml (7.4%). The TNM stage T1a+T1b comprised 7.6% of patients, stage T2a+T2b comprised 20.3%, stage T2c 38.9%, stage T3a 20.3% and over T3a only 12.9%. There were 9.5% cases with Gleason scores of 2-4, 41.5% with scores of 5-6, 30.2% with scores of 7 and 18.8% with scores of 8 - 10. The average operative duration was 216 minutes and the average intraoperative bleeding was 760 ml. Intraoperative complications included one massive hemorrhage (1.9%), one rectal injury (1.9%) and one obturator nerve injury (1.9%). Early postoperative complications consisted of urinary incontinence (14 cases, 25.9%), bladder neck stricture (5 cases, 9.3%), acute urinary retention (4 cases, 7.4%), pelvic effusion (2 cases, 3.8%), lymphocele (1 case, 1.9%) and vesicorectal fistula (only 1 case, 1.9%). For late postoperative complications, total incontinence or severe incontinence occurred in 6 cases (11.1%), urge incontinence in 2 cases (3.8%) and bladder neck contracture in 8 cases (14.8%). The total postoperative recurrence rate was 14.8%. Only 5 cases of biochemical recurrence were noted (9.3%). One case (1.9%) of local recurrence associated with elevated PSA was found. There were 2 cases of distant metastasis with elevated PSA (3.8%). CONCLUSION: Radical prostatectomy is a safe and effective method for the treatment of localized prostate cancer in Macau.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy: a retrospective study.

To evaluate the efficacy of nephrostomy balloon dilation (NBD) for patients who developed vesicourethral anastomotic stricture (VAS) following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life (QoL), International Prostate Symptom Score (IPSS) and maximal urinary flow rate (Qmax) were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy (RRP), and 86 underwent laparoscopic radical prostatectomy (LRP). Most patients (90.3%) had T2 or T3 prostate cancer and a pathological Gleason score of ≤ 7. Forty-five (8.2%) and four (4.7%) patients developed VAS due to radical or LRP, respectively. Forty (89%) patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s-1 (interquartile range (IQR), 2.3-5.6) before dilation and improved to 16 ml s-1 (IQR, 15-19) and 19 ml s-1 (IQR, 18-21) at the 1- and 12-month follow-up, respectively (P < 0.01). Fifteen (37.5%) patients had urinary incontinence prior to dilation, whereas only three (7.5%) patients had incontinence 12 months following dilation (P < 0.01). The median IPSS score improved from 19 (IQR, 17-24) before dilation to 7 (IQR, 6-8) at 12 months following dilation, and the QoL score improved from 5 (IQR, 4-6) before dilation to 2 (IQR, 2-3) at 12 months following dilation (P < 0.01 in both). VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS.