The legitimate role of radical prostatectomy remains controversial. A prospective study was started at the Mayo Clinic in 1950 to evaluate therapeutic usefulness of the operation. Rigid criteria were established for selection of surgical candidates. From 1950 through 1972, 264 patients had radical prostatectomy for cancer at this clinic. Of 115 patients treated by radical perineal prostatectomy at least 10 years ago, 72% have lived from 10-21 years with 57% showing no clinical evidence of the disease. Of 74 patients operated on 15 or more years ago, 54% have survived for 15-21 years and 48% of these survivors appear to be cancer-free. Sue and grade of the adenocarcinoma in- fluenced survival. Endocrine therapy, which was deferred until development of recurrence or metastasis, may have increased longevity in some instances. Radical prostatectomy for cancer has both curative and palliative potentialities in properly selected cases. It should be utilized more frequently, rationally, and effectively.
ECAUSE OF THE VAGARIES OF PROSTATIC
B cancer, the legitimate role of total prostatectomy probably always will be controversial. Ever since Young14 performed his first radical perineal prostatectomy for this clinical chameleon in March 1904 with Halsted as his assistant, there have been innumerable "conscientious objectors." Several factors that have contributed to this antipathy include: (1) failure of many surgeons to master the precise technical demands of the procedure, even after the introduction of Millin'slo retropubic approach in 1945; (2) persistence of the thought that any clinically detectable prostatic cancer is already incurable; (3) promotion of conservative endocrinologic and radiologic management rather than of radical prostatic surgery; (4) unwillingness of patients to accept the physiologic price of either postoperative impotence or stress incontinence of urine or both; and (5) most disastrous of all, continuation of maldirected perineal and retropubic operations in improperly selected patients by poorly qualified surgeons.