Radical perineal prostatectomy without pelvic lymphadenectomy: Selection criteria and early results

Purpose: We evaluated the surgical efficacy of radical perineal prostatectomy and determined preoperative parameters to identify patients at low risk for nodal metastasis. Materials and Methods: Of 155 men evaluated for radical perineal prostatectomy, 74 were assigned to a low risk category (prostate specific antigen less than 10 ng./ml., Gleason score less than 7). Of the patients 40 underwent laparoscopic lymph node dissection and 34 did not. This group was compared to 81 patients who underwent surgical staging and did not fit the low risk criteria. Results: None of 74 patients in the low risk group had nodal metastasis, while metastasis was present in 5 of 81 (6.1%) who did not meet such parameters. Organ-confined disease was present in 71.6% of men with low risk criteria, which was a significantly different rate than the 51.9% found in the other 81 men. Conclusions: Radical perineal prostatectomy confers adequate cancer control and can be performed without pelvic node dissection in select patients.