OBJETIVOS: A introdução de terapia adjuvante pós-prostatectomia radical foi recentemente proposta na literatura na tentativa de se obter melhores taxas de sobrevida em pacientes com câncer de próstata com maior risco de recidiva da doença. Alguns parâmetros anatomopatológicos têm sido considerados bons determinantes dos riscos de recorrência local ou à distância desses tumores. Recentemente o volume tumoral e a presença de padrão terciário de Gleason menos diferenciado foram apresentados como os melhores indicadores do comportamento do carcinoma da próstata. A proposta deste estudo é avaliar a importância da presença e porcentagem do padrão 4 de Gleason e do volume tumoral na evolução de pacientes portadores da adenocarcinoma bem diferenciado de próstata, tratados com prostatectomia radical. MÉTODOS: Setenta e sete pacientes portadores de adenocarcinoma bem diferenciado da próstata, Gleason 6 ou menos, submetidos a prostatectomia radical entre 1995 e 1997 foram estudados. Trinta e sete pacientes sofreram recidiva bioquímica (PSA > 0,4 ng/ml), e 40 pacientes permaneceram livres de doença após seguimento mínimo de cinco anos. A presença e porcentagem do padrão 4 de Gleason, a porcentagem de tumor comprometendo a glândula (considerado como "volume tumoral"), a infiltração capsular e a invasão do tecido extraprostático foram submetidos a análise uni e multivariada para determinação da associação destes parâmetros com a recidiva bioquímica. RESULTADOS: O volume tumoral foi o parâmetro mais importante para determinação da recorrência bioquímica em análises uni e multivariadas. A mediana do volume foi de 25% nos pacientes que sofreram recidiva e 11,5% naqueles que permaneceram livres de doença (p=0,003). A porcentagem de padrão 4 de Gleason foi importante apenas em análise univariada. A mediana da porcentagem de Gleason 4 foi de 7,5% para os pacientes que não sofreram recidiva e de 19% naqueles que recidivaram (p=0,046). CONCLUSÃO: O volume do adenocarcinoma de próstata é um parâmetro objetivo, de fácil avaliação e importante na previsão da recidiva bioquímica no carcinoma bem diferenciado da próstata. Por outro lado, a porcentagem do padrão menos diferenciado de Gleason também serve para prever recidiva à distância. Ambos os parâmetros devem ser incorporados em estudos futuros de terapias adjuvantes para o carcinoma da próstata.

INTRODUCTION: Early introduction of adjuvant radiation or hormone therapy after radical prostatectomy has been advocated in recent literature aiming to improve survival rates in high risk prostate cancer. Traditional prognostic parameters such as serum PSA, Gleason score and clinical stage have been used to identify these cases however accuracy is far from ideal. Recently, tumor volume and presence and percentage of a tertiary less differentiated Gleason pattern have been considered better indicators of prostate cancer behavior. The purpose of this study was to evaluate the importance of presence and percentage of a Gleason pattern 4 and of tumor volume in the outcome of patients treated for well-differentiated prostate adenocarcinoma. METHODS: Seventy seven patients submitted to radical prostatectomy for well-differentiated prostate carcinoma, Gleason score 6 or less, and followed up for at least 5 years were selected. Thirty seven experienced biochemical recurrence while 40 did not. The percentage of Gleason pattern 4, the percentage of the gland involvement (considered as "tumor volume"), capsular invasion and extraprostatic extension were submitted to univariate and multivariate analyses for the evaluation of possible associations with biochemical recurrence. RESULTS: Tumor volume was the most important parameter to predict biochemical recurrence by univariate and multivariate analysis. The median of tumor volume was 25.0% for patients who suffered recurrence, and 11.5% for those with no recurrence (p=0.003). The percentage of Gleason pattern 4 was predictive of recurrence in univariate analysis only. The median percentage of Gleason pattern 4 was 7.5% for patients without recurrence and 19.0% for those who presented recurrence (p=0.046). CONCLUSION: Tumor volume is very objective, easy to evaluate and the most important parameter to predict biochemical recurrence in well-differentiated adenocarcinoma of the prostate. On the other hand, presence and percentage of a tertiary less differentiated Gleason pattern correlated with systemic relapse. Both parameters should be included in future studies to evaluate the role of adjuvant therapy in high risk prostate cancer.

OBJECTIVE: Rupture of vesicourethral anastomosis following radical retropubic prostatectomy is a complication that requires immediate management. We evaluated the morbidity of this rare complication. MATERIALS AND METHODS: We analyzed retrospectively 5 cases of disruption of vesicourethral anastomosis during post-operative period in a consecutive series of 1,600 radical retropubic prostatectomies, performed by a single surgeon. RESULTS: It occurred in a ratio of 1:320 prostatectomies (0,3%). Management was conservative in all the cases with an average catheter permanence time of 28 days, being its removal preceded by cystography. Two cases were secondary to bleeding, 1 followed the change of vesical catheter and 2 by unknown causes after removing the Foley catheter. Only one patient evolved with urethral stenosis, in the period ranging from 6 to 120 months. CONCLUSION: Rupture of vesicourethral anastomosis is not related to the surgeon's experience, and conservative treatment has shown to be effective.