16%

10%

30%

3%

1%

most patients diagnosed with prostate cancer receive the same treatment.

outcome measures are similar.

the treatment outcomes in any patient series may be influenced by the malignant potential of the tumors as well as the treatment used.

there are many effective treatments for clinically localized prostate cancer.

randomized clinical trials eliminate selection bias.

the potential benefits of surgery do not outweigh potential complications in men with a life expectancy of less than 10 years and a low-grade prostate cancer.

an accurate assessment of clinically insignificant or indolent cancers is determined by biopsy results.

in most watchful waiting studies, only about 15% of patients develop objective evidence of tumor progression within 5 years.

a prospective, randomized clinical trial demonstrated similar local cancer progression and metastasis rates for patients with clinically localized prostate cancer managed with deferred treatment and radical prostatectomy.

watchful waiting allows timely intervention as long as patients with localized prostate cancer are followed up semiannually with digital rectal examination and PSA levels.

Gleason pattern 4 or 5 present

PSA velocity less than 0.5 ng/mL/year

Previous cryotherapy of the prostate gland

Any positive repeat biopsy

More than 10% of a biopsy core involvement

Preservation of the external sphincter muscle that yields urinary continence rates in excess of 90%

Discovery that the pudendal nerves are responsible for urinary continence

Frequent use of saturation biopsy under general anesthesia

Elimination of pelvic lymphadenectomy in patients with low-risk tumor features

Magnification provided by robotic-assisted prostatectomy

Laparoscopic: lowest positive surgical margin rate

Retropubic: higher risk for rectal injury and postoperative fecal incontinence

Laparoscopic: lowest complication rate

Perineal: more blood loss and a longer operative time than the retropubic approach

Robotic: three-dimensional visualization

Cancer-specific survival probability

Biochemical recurrence-free probability

Clinical stage

Gleason score

Pathologic stage

release the endopelvic fascia after the neurovascular bundle dissection.

use bipolar electrocautery to transect the urethra.

dissect the neurovascular bundles free of the posterolateral surface of the prostate gland.

perform a retrograde dissection to identify the neurovascular bundles at the bladder neck.

use a harmonic scalpel to release neurovascular bundles.

Preoperative renal function

Patient age

Performance of nerve-sparing surgery

Pathologic tumor stage

Bladder neck–sparing dissection

absence of postoperative radiation therapy.

absence of a smoking history.

nerve-sparing status.

absence of preoperative hormonal therapy.

absence of antihypertensive therapy.

It should be treated immediately with combined androgen blockage therapy.

It does not exceed an increase of 2 ng/mL following radiation therapy.

It usually occurs within 2 years of radiation therapy.

It is strongly associated with an intermittent androgen ablation therapy.

It is more commonly associated with external beam radiation therapy.

Three consecutive rises of PSA following radiation therapy and back-dates the time of cancer progression to halfway between the second and third rise of PSA levels

Three consecutive PSA increases of total 2 ng/mL after reaching a PSA nadir

Three PSA increases measured 12 months apart and back-dates the time of cancer progression to halfway between the first and the second rising PSA levels

Three consecutive rises of PSA following radiation therapy with at least one PSA bounce

Three consecutive PSA increases measured 6 months apart and back-dates the time of cancer progression to halfway between the PSA nadir and the first rising PSA level

Previous radical retropubic prostatectomy

Serum PSA less than 2 ng/mL

History of hematospermia

Previous transurethral resection of prostate (TURP)

Lower urinary tract symptoms

Extracapsular tumor extension

PSA doubling time of more than 3 months

Preoperative PSA less than 10 ng/mL

Preradiation PSA greater than 2 ng/mL

Positive surgical margin

Concurrent hormonal therapy

Lymph node metastasis

Initiation of salvage radiotherapy after PSA has risen above 2 ng/mL

PSA doubling time of less than 6 months

Previous robot-assisted laparoscopic prostatectomy