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Date of Graduation

8-2003

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Randy Randolph, PA-C

Abstract

Objective. Adenocarcinoma of the prostate is the most commonly detected cancer and the second leading cause of cancer related deaths in American men. The increased application of serum PSA has led to an increase in the number of diagnoses and earlier diagnoses of CaP. The surgical treatment of choice for organ-confined prostate cancer is RRP. This surgical method is not without risk; possible post-surgical complications include, but are not limited to, ED, ill and urethral strictures. The goal of this study is to evaluate outcomes following RRP at The Urology Clinic (Portland, OR). My hope is that patients with CaP will be able to make a more informed decision regarding surgical treatment and possible outcomes. This research will also allow the clinic and surgeons to assess their patient outcomes compared to published literature outcomes (urethral strictures 6.7%, VI 10-30% and ED 40-80%).

Methods. A retrospective chart review was' conducted of patients who underwent RRP for,CaP from May 31, 1996 through February 28,2003. The review included RRP performed at Legacy and Providence Health Systems by two of the surgeons at The Urology Clinic. Cure of disease (based on serum PSA, 5 years post surgery) and incidence of ED, VI and urethral strictures were recorded. Patients were mailed a survey to complete and return anonymously.

Results. Incontinence: 32/74 (43.2%) of subjects reported having complete control over urine; 42/74 (56.8%) reported leaking small amounts of urine, but only at certain times; of the subjects leaking small amounts of urine, 37/43 (86%) reported using 0-1 pad per day to control leakage. Erectile Dysfunction: 52/78 (66.7%) of subjects reported having some difficulty with sexual activity (a little, some, a lot); 60/74 (81.1%) reported the need to use sexual aids to maintain an adequate erection. Urethral strictures/bladder neck contractures: Chart review revealed an incidence of 24.2% for urethral stricture/bladder neck contractures, based on procedures performed. Cure of disease: Five year post-operative PSA showed a cure rate of 94.1 %, based on a PSA value <1.0ng/dL.

Conclusion. In the hands of a skilled surgeon who performs many RRP, the cure of disease is very high and the incidence of sexual and urinary complications is low.

Comments

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