title: A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes.
abstract: BACKGROUND
  The optimal management strategy for men with newly diagnosed clinically localized prostate cancer remains a matter of debate. Numerous series have reported cancer control and quality-of-life (QoL) outcomes following treatment with radical prostatectomy (RP).
  
  
  OBJECTIVE
  Critically review published oncologic and functional outcomes after RP, and evaluate factors associated with these outcome measures.
  
  
  METHODS
  A review of the literature was performed using the Medline and Web of Sciences databases. Relevant reports published between 1980 and 2011 identified using the keywords prostate cancer, radical prostatectomy, prostate-specific antigen, biochemical recurrence, incontinence, and erectile dysfunction were reviewed and summarized.
  
  
  RESULTS
  Cancer control rates following RP largely depend on the definition of treatment efficacy. While up to 40% of men have been reported to experience postoperative biochemical recurrence on long-term follow-up, death from prostate cancer has been noted in <10% of men at 15 yr after surgery in contemporary series. For men with high-risk disease, surgery affords pathologic staging, thereby facilitating the selective application of secondary therapies, and has been associated with decreased mortality risk versus radiation in retrospective series. Reported functional outcomes after surgery, particularly urinary continence and erectile dysfunction, have varied greatly to date. These assessments have been limited by nonstandardized reporting methodology. The use of robot-assisted radical prostatectomy has increased in recent years, and while follow-up is thus far short, available data do not suggest the superiority of either approach in terms of functional or oncologic outcomes.
  
  
  CONCLUSIONS
  RP is associated with excellent long-term cancer control. Continued efforts to conduct prospective assessments of postoperative functional outcomes are necessary using validated QoL instruments. The importance of surgical approach will also require further study, incorporating comparative oncologic, functional, and economic data.
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA. boorjian.stephen@mayo.edu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schaeffer
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology