Trial of Modifications to Radical Prostatectomy

This study aims to determine how different ways of performing prostate cancer surgery affect patient outcomes, such as recurrence of cancer or regaining control of bladder function (continence) after surgery. Surgery to remove the prostate is known as a "radical prostatectomy". Surgeons know many things about the best way to do a radical prostatectomy. However, there is uncertainty about some methods of surgery.

All of the surgeons who are taking part in this study have used these techniques at different times. However, they are unsure as to what is the best approach. This trial will evaluate whether the following two aspects of surgical technique influence outcome:

Lymph node template. Prostate cancer can sometimes spread to the lymph nodes near the prostate. Surgeons often remove these lymph nodes to make sure that no cancer is left in the body. However, there is uncertainty about which lymph nodes to remove (the "template"). In particular, not all surgeons think that it is important to remove a large number of lymph nodes. Some believe that prostate cancer found in the lymph nodes is not aggressive. As a result, these surgeons feel that removing additional lymph nodes does not improve the chance that a patient will be cured. In the study patients will either have the standard lymph node dissection or a modified approach.

Fascial suturing. After surgery, patients can sometimes have long-term urinary incontinence. This is when a patient cannot control urine, and drips or leaks urine. Surgeons believe that what happens to the urethra (the tube that carries urine from the bladder to the penis) during surgery can affect the risk of incontinence. One idea is that additional stitches ("sutures") of the urethra to the connective tissue ("fascia") near the prostate during the surgery could be helpful, but this is not known for sure. In the study patients will either have the additional fascial suturing or no additional suturing.