Abstract
Purpose: Radical prostatectomy remains an attractive treatment option for localized prostate cancer. The decision to perform a radical retropubic prostatectomy (RRP) or radical perineal prostatectomy (RPP) fundamentally depends on the practice of the particular urologist. We sought to contrast these two approaches in terms of perioperative outcome measures and economic implications.
Materials and methods: From July 1998 to June 2003, 148 patients at our institution underwent radical prostatectomy for clinically organ confined adenocarcinoma of the prostate (T1–T2, N0, M0). There were 109 RRPs and 39 RPPs. Preoperative characteristics including age, Gleason score and PSA were obtained. The perioperative parameters evaluated included total hospital charges, operative time, estimated blood loss, transfusion rate and length of hospital stay. Statistical analyses using a Student's t-test were performed.
Results: The two patient groups (RRP vs. RPP) were statistically identical in terms of mean age (60 vs. 58 years), mean Gleason score (6.9 vs. 7.0) and mean PSA (7.8 vs. 7.9 ng/ml). The mean hospital charge was nearly $4000 less for the RPP group ($17,739 vs. $13,779). No difference existed in the mean operative durations of each procedure (227 vs. 218 min). The estimated blood loss (857 vs. 521 cc), transfusion rate (58% vs. 36%), and mean length of hospital stay (4.6 vs. 3.6 days), were statistically less for the RPP group ( respectively).
Conclusions: Radical perineal prostatectomy offers the patient a perioperative advantage in terms of lower blood loss, transfusion requirement and shorter hospital stay in addition to a significant charge benefit appeal compared to radical retropubic prostatectomy.