the treatment outcomes in any patient series may be influenced by the malignant potential of the tumors as well as the treatment used.
randomized clinical trials eliminate selection bias.
most patients diagnosed with prostate cancer receive the same treatment.
there are many effective treatments for clinically localized prostate cancer.
outcome measures are similar.
in most watchful waiting studies, only about 15% of patients develop objective evidence of tumor progression within 5 years.
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.
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.
an accurate assessment of clinically insignificant or indolent cancers is determined by biopsy results.
watchful waiting allows timely intervention as long as patients with localized prostate cancer are followed up semiannually with digital rectal examination and PSA levels.
Any positive repeat biopsy
Gleason pattern 4 or 5 present
More than 10% of a biopsy core involvement
PSA velocity less than 0.5 ng/mL/year
Previous cryotherapy of the prostate gland
Elimination of pelvic lymphadenectomy in patients with low-risk tumor features
Magnification provided by robotic-assisted prostatectomy
Preservation of the external sphincter muscle that yields urinary continence rates in excess of 90%
Frequent use of saturation biopsy under general anesthesia
Discovery that the pudendal nerves are responsible for urinary continence
Robotic: three-dimensional visualization
Laparoscopic: lowest positive surgical margin rate
Retropubic: higher risk for rectal injury and postoperative fecal incontinence
Perineal: more blood loss and a longer operative time than the retropubic approach
Laparoscopic: lowest complication rate
Biochemical recurrence-free probability
Cancer-specific survival probability
perform a retrograde dissection to identify the neurovascular bundles at the bladder neck.
release the endopelvic fascia after the neurovascular bundle dissection.
dissect the neurovascular bundles free of the posterolateral surface of the prostate gland.
use bipolar electrocautery to transect the urethra.
use a harmonic scalpel to release neurovascular bundles.
Preoperative renal function
Bladder neck–sparing dissection
Performance of nerve-sparing surgery
Pathologic tumor stage
absence of antihypertensive therapy.
absence of preoperative hormonal therapy.
absence of a smoking history.
absence of postoperative radiation therapy.
It is more commonly associated with external beam radiation 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 is strongly associated with an intermittent androgen ablation therapy.
It usually occurs within 2 years of radiation therapy.
Three consecutive rises of PSA following radiation therapy with at least one PSA bounce
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 and back-dates the time of cancer progression to halfway between the second and third rise of PSA levels
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
Three consecutive PSA increases of total 2 ng/mL after reaching a PSA nadir
Lower urinary tract symptoms
History of hematospermia
Previous transurethral resection of prostate (TURP)
Previous radical retropubic prostatectomy
Serum PSA less than 2 ng/mL
Preoperative PSA less than 10 ng/mL
Preradiation PSA greater than 2 ng/mL
Extracapsular tumor extension
PSA doubling time of more than 3 months
Positive surgical margin
Initiation of salvage radiotherapy after PSA has risen above 2 ng/mL
Lymph node metastasis
Previous robot-assisted laparoscopic prostatectomy
Concurrent hormonal therapy
PSA doubling time of less than 6 months
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