Radical prostatectomy in the management of stage-A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 11 of the 29 stage-A1 patients (38%) and in 66 of the 86 stage-A2 patients (77%). 14% of the stage-A1 patients and 29.5% of the stage-A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients are alive, and only 3 patients suffered disease progression. These 3 patients were among the stage-A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. 26 patients who also had evidence of disease extension are alive without evidence of disease. These data demonstrate that patients with stage-A disease are at risk for disease progression if left untreated and, with morbidity as low as achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.