Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Radical prostatectomy for localized prostate cancer

Eric A Klein, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editors
Wenliang Chen, MD, PhD
Michael E Ross, MD


Standard management options for men with clinically localized prostate cancer include radical prostatectomy, radiation therapy (RT), including external beam RT and/or brachytherapy, and for appropriately selected patients, active surveillance. Patients treated with RT who were classified as high risk based upon pretreatment assessment and those managed with radical prostatectomy who have significant adverse pathologic findings (positive margins, seminal vesicle invasion, persistent elevation of serum prostate specific antigen [PSA]) may require a combined modality approach.

The role of radical prostatectomy in the treatment of clinically localized prostate cancer will be reviewed here. Overall treatment options for men with newly diagnosed prostate cancer and the factors influencing the choice of therapy are discussed separately based upon the risk of recurrence and the extent of disease:

(See "Prostate cancer: Risk stratification and choice of initial treatment".)

(See "Initial approach to low- and very low-risk clinically localized prostate cancer".)

(See "Initial management of regionally localized intermediate-, high-, and very high-risk prostate cancer".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Iversen P, Madsen PO, Corle DK. Radical prostatectomy versus expectant treatment for early carcinoma of the prostate. Twenty-three year follow-up of a prospective randomized study. Scand J Urol Nephrol Suppl 1995; 172:65.
  2. Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012; 367:203.
  3. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med 2014; 370:932.
  4. Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. N Engl J Med 2017; 377:132.
  5. Trinh QD, Sammon J, Sun M, et al. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2012; 61:679.
  6. Sooriakumaran P, Srivastava A, Shariat SF, et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol 2014; 66:450.
  7. Stephenson AJ, Eggener SE, Hernandez AV, et al. Do margins matter? The influence of positive surgical margins on prostate cancer-specific mortality. Eur Urol 2014; 65:675.
  8. Herlemann A, Cowan JE, Carroll PR, Cooperberg MR. Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy. Eur Urol 2017.
  9. Hu JC, Gu X, Lipsitz SR, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009; 302:1557.
  10. Wood DP, Schulte R, Dunn RL, et al. Short-term health outcome differences between robotic and conventional radical prostatectomy. Urology 2007; 70:945.
  11. Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016.
  12. Trinh QD, Bjartell A, Freedland SJ, et al. A systematic review of the volume-outcome relationship for radical prostatectomy. Eur Urol 2013; 64:786.
  13. Vickers A, Bianco F, Cronin A, et al. The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. J Urol 2010; 183:1360.
  14. Vickers AJ, Savage CJ, Hruza M, et al. The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol 2009; 10:475.
  15. Secin FP, Savage C, Abbou C, et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol 2010; 184:2291.
  16. Thompson JE, Egger S, Böhm M, et al. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. Eur Urol 2014; 65:521.
  17. Sivaraman A, Sanchez-Salas R, Prapotnich D, et al. Learning curve of minimally invasive radical prostatectomy: Comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 2017; 35:149.e1.
  18. Parker PA, Pettaway CA, Babaian RJ, et al. The effects of a presurgical stress management intervention for men with prostate cancer undergoing radical prostatectomy. J Clin Oncol 2009; 27:3169.
  19. Berglund RK, Sadetsky N, DuChane J, et al. Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urol 2007; 177:526.
  20. Allaf ME, Palapattu GS, Trock BJ, et al. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 2004; 172:1840.
  21. Abdollah F, Suardi N, Gallina A, et al. Extended pelvic lymph node dissection in prostate cancer: a 20-year audit in a single center. Ann Oncol 2013; 24:1459.
  22. Weiner AB, Matulewicz RS, Eggener SE, Schaeffer EM. Increasing incidence of metastatic prostate cancer in the United States (2004-2013). Prostate Cancer Prostatic Dis 2016; 19:395.
  23. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on April 27, 2012).
  24. Klein EA, Kattan M, Stephenson A, Vickers A. How many lymphadenectomies does it take to cure one patient? Eur Urol 2008; 53:13.
  25. Zwergel U, Lehmann J, Wullich B, et al. Lymph node positive prostate cancer: long-term survival data after radical prostatectomy. J Urol 2004; 171:1128.
  26. Wawroschek F, Wagner T, Hamm M, et al. The influence of serial sections, immunohistochemistry, and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. Eur Urol 2003; 43:132.
  27. Mattei A, Fuechsel FG, Bhatta Dhar N, et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 2008; 53:118.
  28. Alemozaffar M, Regan MM, Cooperberg MR, et al. Prediction of erectile function following treatment for prostate cancer. JAMA 2011; 306:1205.
  29. Ohori M, Wheeler TM, Kattan MW, et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 1995; 154:1818.
  30. Ng CS, Klein EA. Acute complications after radical retropubic prostatectomy. Prostate J 2000; 2:22.
  31. Klein EA, Grass JA, Calabrese DA, et al. Maintaining quality of care and patient satisfaction with radical prostatectomy in the era of cost containment. Urology 1996; 48:269.
  32. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008; 358:1250.
  33. Kundu SD, Roehl KA, Eggener SE, et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004; 172:2227.
  34. Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000; 55:58.
  35. Sivarajan G, Prabhu V, Taksler GB, et al. Ten-year outcomes of sexual function after radical prostatectomy: results of a prospective longitudinal study. Eur Urol 2014; 65:58.
  36. Lee JK, Assel M, Thong AE, et al. Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy. Eur Urol 2015; 68:899.
  37. Raina R, Agarwal A, Zippe CD. Management of erectile dysfunction after radical prostatectomy. Urology 2005; 66:923.
  38. Schover LR, Fouladi RT, Warneke CL, et al. The use of treatments for erectile dysfunction among survivors of prostate carcinoma. Cancer 2002; 95:2397.
  39. Lowentritt BH, Scardino PT, Miles BJ, et al. Sildenafil citrate after radical retropubic prostatectomy. J Urol 1999; 162:1614.
  40. Hong EK, Lepor H, McCullough AR. Time dependent patient satisfaction with sildenafil for erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy (RRP). Int J Impot Res 1999; 11 Suppl 1:S15.
  41. Mulhall JP, Parker M, Waters BW, Flanigan R. The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function. BJU Int 2010; 105:37.
  42. Raina R, Pahlajani G, Agarwal A, et al. Long-term potency after early use of a vacuum erection device following radical prostatectomy. BJU Int 2010; 106:1719.
  43. Mulhall JP, Bella AJ, Briganti A, et al. Erectile function rehabilitation in the radical prostatectomy patient. J Sex Med 2010; 7:1687.
  44. Garcia FJ, Brock G. Current state of penile rehabilitation after radical prostatectomy. Curr Opin Urol 2010; 20:234.
  45. McCullough AR, Hellstrom WG, Wang R, et al. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. J Urol 2010; 183:2451.
  46. Montorsi F, Brock G, Lee J, et al. Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. Eur Urol 2008; 54:924.
  47. Montorsi F, Brock G, Stolzenburg JU, et al. Effects of tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: a randomised placebo-controlled study (REACTT). Eur Urol 2014; 65:587.
  48. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999; 162:433.
  49. Prabhu V, Sivarajan G, Taksler GB, et al. Long-term continence outcomes in men undergoing radical prostatectomy for clinically localized prostate cancer. Eur Urol 2014; 65:52.
  50. Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol 2005; 48:734.
  51. Van Kampen M, De Weerdt W, Van Poppel H, et al. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet 2000; 355:98.
  52. Manassero F, Traversi C, Ales V, et al. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn 2007; 26:985.
  53. Zhang AY, Bodner DR, Fu AZ, et al. Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial. J Urol 2015; 194:1675.
  54. Geraerts I, Van Poppel H, Devoogdt N, et al. Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial. Eur Urol 2013; 64:766.
  55. Elliott SP, Meng MV, Elkin EP, et al. Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol 2007; 178:529.
  56. Montgomery JS, Gayed BA, Daignault S, et al. Early urinary retention after catheter removal following radical prostatectomy predicts for future symptomatic urethral stricture formation. Urology 2007; 70:324.
  57. Yurkanin JP, Dalkin BL, Cui H. Evaluation of cold knife urethrotomy for the treatment of anastomotic stricture after radical retropubic prostatectomy. J Urol 2001; 165:1545.
  58. Matsubara A, Yoneda T, Nakamoto T, et al. Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach. Urology 2007; 70:1152.
  59. Lughezzani G, Sun M, Perrotte P, et al. Comparative study of inguinal hernia repair rates after radical prostatectomy or external beam radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:1307.
  60. Stranne J, Lodding P. Inguinal hernia after radical retropubic prostatectomy: risk factors and prevention. Nat Rev Urol 2011; 8:267.
  61. Carlsson SV, Ehdaie B, Atoria CL, et al. Risk of incisional hernia after minimally invasive and open radical prostatectomy. J Urol 2013; 190:1757.
  62. Alibhai SM, Leach M, Tomlinson G, et al. 30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity. J Natl Cancer Inst 2005; 97:1525.
  63. Van Hemelrijck M, Garmo H, Holmberg L, et al. Thromboembolic events following surgery for prostate cancer. Eur Urol 2013; 63:354.
  64. Slova D, Lepor H. The short-term and long-term effects of radical prostatectomy on lower urinary tract symptoms. J Urol 2007; 178:2397.
  65. Ramirez D, Maurice MJ, Kaouk JH. Robotic perineal radical prostatectomy and pelvic lymph node dissection using a purpose-built single-port robotic platform. BJU Int 2016; 118:829.
  66. Kaouk JH, Akca O, Zargar H, et al. Descriptive Technique and Initial Results for Robotic Radical Perineal Prostatectomy. Urology 2016; 94:129.
  67. Iselin CE, Robertson JE, Paulson DF. Radical perineal prostatectomy: oncological outcome during a 20-year period. J Urol 1999; 161:163.
  68. Lance RS, Freidrichs PA, Kane C, et al. A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group. BJU Int 2001; 87:61.
  69. Martis G, Diana M, Ombres M, et al. Retropubic versus perineal radical prostatectomy in early prostate cancer: eight-year experience. J Surg Oncol 2007; 95:513.
  70. Eggener SE, Scardino PT, Walsh PC, et al. Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol 2011; 185:869.
  71. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med 2016; 375:1415.
  72. Donovan JL, Hamdy FC, Lane JA, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2016; 375:1425.