688

INTRAOPERATIVE BLOOD LOSS AND TRANSFUSION REQUIREMENTS FOR ROBOTIC ASSISTED RADICAL PROSTATECTOMY VERSUS RADICAL RETROPUBIC PROSTATECTOMY

Monday, May 23, 2005

Scott B Farnham*, Todd M Webster, S Duke Herrell, Joseph A Smith, Jr, Nashville, TN

INTRODUCTION AND OBJECTIVE: We compared intraoperative blood loss, perioperative hematocrit, and transfusion requirements in patients undergoing radical retropubic prostatectomy (RRP) versus robotic assisted laparoscopic prostatectomy (RALP) by a single surgeon.

METHODS: Over a 15 month period, 279 patients with localized carcinoma of the prostate desiring surgery were prospectively enrolled in this comparative study. The decision of which surgical approach was by patient choice after discussion of the perceived pros and cons of each alternative. 176 patients received RALP and 103 patients underwent RRP. Serum hematocrit was obtained preoperatively and 24 hours postoperatively in all patients. Intraoperative blood loss was recorded and transfusion requirements were noted.

RESULTS: Patients in the RALP group had significantly less intraoperative blood loss compared to the RRP group (mean of 191cc vs. 664 cc, p<0.001). Additionally, there was a significant difference in the discharge hematocrit (36.8% vs. 32.8%, p<0.001) and mean perioperative change in hematocrit (8.0 percentage point decrease vs. a 10.7 point decrease, p<0.001) between the RALP and RRP groups respectively. Three patients in the RRP group required transfusion (2.9%) and one patient in the RALP group (0.5%), which was not statistically significant (p=0.14).

CONCLUSIONS: We have shown that RALP is associated with less intraoperative bleeding than RRP and that patients undergoing RALP have a higher serum hematocrit at hospital discharge. The clinical significance of these findings will ultimately be determined by further comparison of these two surgical groups through quality of life assessment.

951

PSA VELOCITY AND RISK OF PROSTATE CANCER DEATH IN THE BALTIMORE LONGITUDINAL STUDY OF AGING

Monday, May 23, 2005

H Ballentine Carter*, Luigi Ferrucci, E Jeffrey Metter, Baltimore, MD

INTRODUCTION AND OBJECTIVE: The rate of rise in PSA (PSA velocity or PSAV) is greater for men with prostate cancer compared to those without the disease, and in those at higher risk of a prostate cancer death after surgery followed short term. We evaluated the long term risk of prostate cancer death among participants in an aging study.

METHODS: 502 men (114 prostate cancer cases, 388 without prostate cancer) with at least 3 PSA measurements (median 7, 3-15) had a median follow-up of 15.4 (1.7-38.8) years from first to last PSA level. PSA values were determined at study visits or on frozen sera samples, and were censored at the time of diagnosis of prostate cancer for 114 cancer cases, or at the time of treatment for prostate enlargement (surgical and medical). There were 11 deaths from prostate cancer and 120 of another cause. The median age (range) in years was 80 (68-90) for those who died of prostate cancer, 81 (54-98) for those dead of a non prostate cancer cause, 74 (49-97) for those diagnosed with prostate cancer, and 66 (28-97) for those alive without prostate cancer. PSAV was determined from the slope of the PSA measurements using linear regression analysis, and death from prostate cancer was evaluated as a function of PSAV.

RESULTS: PSAV (ng/ml per year) was equal to or below 0.01, 0.01-0.06, above 0.06 to 0.16, and above 0.16 for quartile 1 through 4. The cumulative proportion of men who died of prostate cancer in each quartile from lowest to highest was 0, 0.8%, 0, and 8%.

CONCLUSIONS: PSAV may be one method for identifying those men who have a life threatening cancer and who will benefit from aggressive therapy of their disease.

999

PROSPECTIVE NON-RANDOMIZED COMPARISON OF STANDARD NERVE SPARING AND THE “VEIL OF APHRODITE”: ANALYSIS OF POST OPERATIVE POTENCY USING THE INTERNATIONAL INDEX OF ERECTILE FUNCTION - 5 QUESTIONNAIRE.

Tuesday, May 24, 2005

Mani Menon, Sanjeev Kaul*, Akshay Bhandari, Alok Shrivastava, Ashok K Hemal, Detroit, MI

INTRODUCTION AND OBJECTIVE: Anatomical nerve-sparing radical prostatectomy provides excellent long term cancer control, however recovery of sexual function is variable. However recent reports indicate that there is a lattice work of nerves on the ventral and lateral prostatic fascia. These "accessory nerves" may not be important in sexually healthy individuals, but may be critical when the erectile machinery is damaged. We have described a technique to preserve the lateral prostatic fascia, the “Veil of Aphrodite”; that appears to enhance the quality of nerve preservation during robotic radical prostatectomy (VIP). In January 2003 we initiated a prospective, non-randomized study comparing the outcomes of patients undergoing the veil with those undergoing standard nerve-sparing robotic prostatectomy. We describe the outcomes of this study at 12 months follow-up.

METHODS: From January to August 2003, 58 potent men (International Index of Erectile Function - 5 (IIEF-5) score > 21 without any medication) underwent VIP, 35 with the veil of Aphrodite, and 23 with standard nerve sparing techniques. Potency was assessed with self-administered IIEF-5 questionnaires 12 months after surgery. The primary end point of analysis was the achievement of normal erections (IIEF-5>21) without medications. Secondary end points were the ability to achieve either normal erections or any erection (IIEF-5 >5) strong enough for vaginal penetration with or without phosphodiesterase 5 inhibitors.

RESULTS: 13 of 35 patients (47.5%) patients in the veil group and 1 of 30 (3%) patients in the standard nerve sparing group achieved normal erections (IIEF-5 >21) without any medication (p<.0001). 28(80%) veil patients and 3 (13%) standard nerve-sparing patients achieved normal erections (IIEF-5 >21) with phosphodiesterase 5 inhibitors.(p<0.0001). 38(95%) of veil and 20 (71.5%) of standard patients achieved erections strong enough for sexual intercourse(p=0.002).

CONCLUSIONS: In our hands, patients undergoing the “Veil of Aphrodite” procedure have significantly better potency outcomes than patients undergoing standard nerve-sparing robotic prostatectomy at 12 months follow up. The results of standard nerve sparing are comparable to other published series.

Read Prostate Cancer: Localized Selected Abstracts - Part 5

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