Radical prostatectomy as treatment of localized prostatic cancer. Early results, with special focus on transrectal ultrasound for local staging.

Radical prostatectomy was performed for localized prostatic cancer on 68 patients (mean age 65 years). Rectal palpation alone was used to determine local operability in the first 38 cases, and its accuracy proved to be 63%. Transrectal ultrasound in conjunction with clinical examination was used instead in the last 30 patients, with 80% accuracy. There was one perioperative death and the total complication rate was 37%. Postoperatively three patients were totally incontinent and five had mild stress incontinence. Of the 29 patients operated on with the nerve-sparing Walsh technique, 11 had penile erections 6 months postoperatively. The mean follow-up time was 34 (4-69) months. Local recurrence or distant metastases were found in 11 cases (16%). In ten of them the primary tumour was locally advanced (pT3 or pT4), and in one it was intracapsular (pT2) but poorly differentiated. Radical prostatectomy is concluded to be safe and its complication rate acceptable. Careful preoperative evaluation of the extent of disease is essential for cure, and transrectal ultrasound increases staging accuracy.