RADICAL PROSTATECTOMY FOR STAGE-B2 PROSTATIC-CANCER

Patients with large, localized prostatic carcinomas (stage B2) may not be good candidates for radical prostatectomy. Inaccuracy of the rectal examination is a particular problem with a lesion of this type. Unrecognized extension beyond the prostatic capsule, especially into the seminal vesicles, is well known and unsuspected involvement of pelvic lymph nodes may be present. Patients with clinical stage B2 prostatic carcinoma who seemed to be potentially good candidates for radical prostatectomy were subjected to pelvic lymphadenectomy for staging. All of these patients have had a normal chest X-ray, serum acid phosphatase, excretory urogram and radioisotope bone scan. During a 10 1/2 yr interval 87 patients with clinical stage B2 prostatic carcinoma underwent staging pelvic lymphadenectomy. Of these patients 24 (28%) had positive pelvic lymph nodes and were excluded from consideration for radical prostatectomy. Fifty patients with clinical stage B2 prostatic carcinoma and proved negative pelvic lymph nodes were subjected to radical prostatectomy: 43 (86%) had tumor confined to the prostate on histologic examination of the radical prostatectomy specimen, 6 (12%) had microscopic capsular invasion and 2 (4%) had microscopic invasion of the seminal vesicles. Radical prostatectomy seems justified when there is a high likelihood that the tumor truly is confined to the substance of the prostate. Pelvic lymphadenectomy has enabled selection of appropriate patients with stage B2 prostatic carcinoma for radical prostatectomy.