What RP Stands For in Medical Treatment
RP stands for Radical Prostatectomy, a surgical procedure for treating clinically localized prostate cancer.
Definition and Procedure
Radical prostatectomy is a surgical procedure in which the entire prostate gland and attached seminal vesicles plus the ampulla of the vas deferens are removed. 1
The procedure can be performed using several surgical approaches 1:
- Retropubic incision (open surgery)
- Perineal incision (open surgery)
- Laparoscopic technique
- Robot-assisted laparoscopic technique (now commonly used with comparable outcomes to open approaches in experienced hands) 1
Nerve-Sparing Considerations
Depending on tumor characteristics and the patient's baseline sexual function, surgeons perform either 1:
- Nerve-sparing RP to preserve erectile function
- Non-nerve-sparing RP when oncologic control takes priority
Recovery of erectile function is directly related to age at RP, preoperative erectile function, and the degree of cavernous nerve preservation 1.
Concurrent Procedures
Pelvic lymphadenectomy (PLND) can be performed concurrently with RP and is generally reserved for patients with higher risk of nodal involvement. 1 An extended PLND is preferred when lymph node dissection is performed, as it discovers metastases approximately twice as often as a limited PLND 1.
Patient Selection Criteria
RP is appropriate therapy for any patient with clinically localized prostate cancer that can be completely excised surgically, who has a life expectancy of ≥10 years, and has no serious comorbid conditions that would contraindicate an elective operation. 1
For intermediate and high-risk patients, radical treatment should be discussed if they have a minimal life expectancy of 10 and 5 years, respectively 1.
Perioperative Course
Generally, healthy patients undergoing RP will be hospitalized for 1-3 days after surgery 1. Patients are discharged with an indwelling urethral catheter for 1-2 weeks to temporarily drain the bladder 1.
Oncologic Benefit
Because the entire prostate gland is removed with RP, the major potential benefit is a cancer cure in patients in whom the prostate cancer is truly localized. 1 Based on randomized controlled trial outcomes, when watchful waiting and RP are compared, RP may be associated with lower risk of cancer recurrence, cancer-related death, and improved survival 1.
Important Caveats
In cases where prostate cancer is high grade, when tumor has spread outside the prostate gland, or when tumor is not completely excised, removing the prostate may not ensure all cancer is eliminated, putting the patient at risk for recurrence 1.
High-volume surgeons in high-volume centers generally provide better outcomes, which should factor into referral decisions 1.
Neoadjuvant androgen deprivation therapy (ADT) for radical prostatectomy is strongly discouraged, as it has not shown benefit and may complicate surgical outcomes 1.