ORLANDO--Impotence and incontinence, the radical prostatectomy complications that patients fear most, can be reduced through simple modifications in surgical technique without compromising cancer control, according to two reports presented at the American Urological Association's 91st annual meeting.
Previous anatomic refinements had brought the positive margin rate down to 8%, but had also resulted in a marked reduction in potency, down to approximately 20%, said Peter T. Scardino, MD, professor and chair of the Scott Department of Urology, Baylor College of Medicine, Houston.
Thus, he developed a new technique, first used in November 1993. "I felt it was very important, if patients were to continue to accept this kind of surgery, to go back and preserve some of the nerve tissue and allow more patients to recover potency while maintaining a low rate of positive margins," he said.
Dr. Scardino noted that the nerves controlling erection lie immediately adjacent to the prostate, near the posterior-lateral area of the prostate, where cancers tend to arise and extend. A major concern, he said, was "whether nerve-sparing to preserve potency could become cancer-sparing," a problem borne out in some series.
His technique permits careful nerve dissection away from the prostate near the apex of the urethra, while getting completely around the cancer. In his analysis of the first 450 patients treated with the new technique, the positive margin rate has remained low overall, at 12%.
"We were able to increase the potency rate at 1 year in men under age 65 to around 58%, rising to 65% at 2 years," he said. In men over age 65, one third were found to be potent after surgery. Age was the second most important determinant of postoperative potency after technique in the multivariate analysis.
"Men need to understand that age is a powerful predictor of recovery of erections," Dr. Scardino said, adding that younger men can afford more compromise in potency because their erections tend to be stronger before surgery. Indeed, preoperative erectile function was the third most important factor linked to postoperative potency in this series.