Outcome and complications of radical prostatectomy in patients with PSA <10 ng/ml: comparison between the retropubic, perineal and laparoscopic approach.

The objective of this work was to evaluate the oncological outcomes and complications of prostate cancer patients with prostate specific antigen (PSA)<10 ng/ml after radical prostatectomy by retropubic, perineal and laparoscopic approach. From 1988 to 2001, 306 patients with PSA<10 ng/ml underwent radical prostatectomy by the retropubic, perineal or laparoscopic approach. Mean operative time, complication rates, length of hospital stay, catheterization time and pathological results were reviewed. Kaplan-Meier analysis was used to evaluate the likelihood of biochemical PSA recurrence. There were no statistical differences between the three groups in terms of preoperative characteristics except for PSA levels (5.5, 6.5 and 6.6 ng/ml for the retropubic, perineal, and laparoscopic approach, respectively, P<0.05) and for the T1c stage prevalence (50%, 43.1% and 68.4%, P<0.05). Operating time was significatively longer in the laparoscopic approach (266 min), whereas transfusion rate (22.1%), bladder catetherization (12.1 days), and length of hospital stay (12.1 days) were higher in the retropubic group (P<0.05). The percentage of medical and surgical complications were 6.9%, 3.1% and 3.4% (P<0.05) and 18.6%, 16.9% and 11.6% (P<0.05) for the retropubic, perineal, and laparoscopic approach, respectively. Pathological staging revealed pT2 in 76.7%, 78.4% and 81.3% for retropubic, perineal and laparoscopic approach, respectively (P<0.05). Positive surgical positive margins were noted in 20.9%, 18.4% and 20.6% (P>0.05). The actuarial 3-year recurrence-free survival rate was 89.3%, 89.2% and 86.2% (P>0.05) for retropubic, perineal and laparoscopic approach, respectively. It can be concluded that in patients with preoperative PSA<10 ng/ml, clinical outcome and complication rates were similar, regardless of the choice of surgical approach.