Oncological and functional results of antegrade radical retropubic prostatectomy for the treatment of clinically localised prostate cancer.

Objectives: To present the oncological outcome of the antegrade radical prostatectomy in the whole series of consecutive patients treated over an 18-yr period, and to report the functional results and complications of the last 488 patients. Patients and methods: We reviewed the clinicopathological data of 845 patients treated between 1988 and 2005. Complete data on continence, potency, and complication were available on the last 488 patients treated between 2000 and 2005. Results: Positive surgical margins were detected in 12.8% of patients. The mean follow-up was 49 mo. The 8-yr biochemical recurrence–free survival rates were 84.1% for pT2, 69.9% for pT3a, and 37.3% for pT3b disease ( p < 0.0001). The multivariate analysis showed stage, PSA, and Gleason score as significant independent predictors of biochemical recurrence– free survival. After 12 mo, 94.1% of patients were continent, and 69.6% of patients who had bilateral nerve-sparing prostatectomy were potent. Mean estimated blood loss was 223 cc; overall incidence of complication was lower than 15%. Conclusions: Antegrade radical prostatectomy provides a low incidence of positive margins and an optimal cancer control. This technique can provide a low incidence of complications, reduced blood loss, and optimal functional results in terms of recovery of continence owing to a complete definition of the anatomical boundaries of the apex. Moreover, it can provide a less challenging nerve-sparing procedure with similar results to those reported by the retrograde approach.