Treatment For Prostate Cancer After
Prostatectomy
Surgery for prostate cancer is becoming safer
This is the main result of the evaluation of a database in which the treatment of men with prostate cancer is detected since 2005. After radical prostatectomy, but more and more advanced tumors are detected.
Prostate cancer can be treated with different methods as well as with surgery, the so-called radical prostatectomy . For the selection of the treatment method, there are no general standards, but only data from individual studies. To obtain data from the practical care of patients who are not pre-selected for study, the tumor center Berlin has set up a special database.
In this system, physicians can document the treatment, especially the operation. In return you get statistics that provide information about the quality of treatment and allow a comparison to other clinicians. Participation is voluntary, both for the doctor and for the patient. The participating physicians undertake to capture all data on their patients, particularly complications, but an external review does not take place.
This database was then evaluated to determine how it is with the quality of radical surgery, and whether this has changed over time: from 2005 to 2008 5218 men were grouped into 17 clinics that were 66 years old on average and a PSA value had of good 7ng/ml. About 70% of them received an open retropubic radical prostatectomy (RRPE, see access routes during the operation ). More than half of the patients had before surgery erectile dysfunction (see erectile dysfunction ), of the other 70% were able to undergo surgery while sparing important for the erection nerves (see nerve sparing during surgery ).
Over time, the proportion of localized tumors (pT2) took something off (from 71% to 64%), but slightly increased the incidence of lymph node metastasis (pN +, from 8% to 10%) and from infected cut edges (R + ie incomplete tumor removal from 23% to 29%, only for pT2 tumors from 12% to 16%). This led the authors to the variety of surgical procedures as well as back to the growing willingness to operate even with a locally advanced tumor.
During the operation period of about 140 minutes remained the same, took the time of hospital stay of 10 from 8 days. The latter was also true for complication such as postoperative bleeding and required secondary interventions: Slight complications decreased from 24.1% to 9.9%, severe 6.5% to 4.2%. This, according to the authors, documents a trend in favor of increasing safety and quality of surgery.
Because of the short follow-up periods no statement about the long-term outcomes (including side effects) could be made of the operation (eg with regard to urinary incontinence , erectile dysfunction, quality of life, survival time).
Conclusion of the authors
The database documentation tumor in patients with prostate cancer allowed the detection and evaluation of important data about the quality and the outcome of treatment. In the participating hospitals most of the parameters over time remained unchanged and the level of the supply stability. However, there was a trend toward more tumors with spread beyond the prostate capsule and also to more infected cut edges determine. The quality of operations increased, however. So showed important quality characteristics such as the complication rate trends for improvement.
Post a Comment