Pelvic lymphadenectomy for localized prostate cancer.

In the era of prostate specific antigen, there is increasing proportion of patients with localized prostate cancer. Accurate preoperative determination of lymph node status is important for adequate selection of treatment option, monitoring of response to treatment and early detection of recurrence. Lymph node invasion (LNI) is crucial prognostic parameter for patients who underwent curative treatment. Despite of continuous improvments of radiological armamentarium, CT, MRI and PET scans are not absolutely reliable in lymph node staging. Many nomograms have been developed for prediction of lymph node status, but accuracy of these statistical models is not better than 78%. Surgery, either open or laparoscopic pelvic lymphadenectmy (PLND), remains a cornerstone in lymph node staging. However, there are several controversies regarding PLND 1) necessity for routine perfoming in each patient, 2) anatomic boundaries for PLND, 3) morbidity of PLND, and 4) diagnostic and therapeutic value.

The nerve sparing radical prostatectomy--a step to better quality of life-surgical aspects.

UNLABELLED: Radical surgical procedure (Radical Retropubic Prostatectomy) is treatment of choice for patients with localized (T1, T2) prostatic cancer. By radiologists, radical radiotherapy (brachi and external beam or only brachi therapy) could, also, be rational radical option for T1, T2. But, long-term survival is better after surgical procedure which is confirmed by many authors. Nerve sparing radical prostatectomy should be considered as a step to better life in all cases where it could be done. With this presentation we would like to point out the critical moments (the places of our-surgical mistakes), where Neurovascular Bundle (NVB) could be injured during the procedure (RRP). If those injures could be avoided urologist would be able to enhance the quality of life of these patients. The possible injures of NVB may happen during: 1. Dissection of the posterior wall of urethra. 2. Separation-dissection of external urethral sphincter. 3. Putting of sutures on urethra. 4. Preparation of the posterior side of prostate. 5. Dissection of the seminal vesicles. CONCLUSION: Careful surgical work of experienced urologist concerning all surgical tips mentioned above will result in an excellent continence (100%),preserved potency (more than 70%), and better quality of life for patients with localized prostate cancer.