Radikal retropubik prostatektomi sonrası cerrahi sınır pozitifliği ile serum PSA düzeyi ve histopatolojik kriterler arasındaki ilişki
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Tarih
2008
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info:eu-repo/semantics/openAccess
Özet
Çalışmanın amacı açık radikal retropubik prostatektomi (RRP) öncesi serum PSA düzeyi ve Gleason skorunun ameliyat sonrası cerrahi sınır pozitifliği üzerine olan etkisini incelemektir. Çalışmamıza sinir koruyucu olmayan açık radikal retropubik prostatektomi ve iki taraflı lenfadenektomi uygulanan ve ameliyat öncesi ve sonrası patoloji değerlendirmesi kliniğimizde yapılan 259 hasta alındı. Ameliyat öncesi PSA düzeyi, biyopsi Gleason skoru, ameliyat sonrası Gleason skoru, histopatolojik evre ile cerrahi sınır pozitifliği arasındaki ilişki incelendi. Tüm hasta grubunda cerrahi sınır pozitifliği %21,2 idi. Cerrahi sınır pozitifliği evre pT2, pT3a, pT3b ve pN1’de sırasıyla %2,6 (3), %26,7 (27), %50 (16) ve %69,2 (9) olarak bulundu. Ameliyat öncesi serum PSA düzeyi 10 ng/ml ve altında olan hastalarda CS pozitifliği %16,7, üstünde %27,6 idi (p<0.05). Biyopsi Gleason skoru 7’nin altında CS pozitifliği %17,5, 7 ve üstünde %33,9 bulundu (p<0.05). Final Gleason skoru 7’nin altında CS pozitifliği %13,6, 7 ve üstünde %34,6 idi (p<0.05). Serum PSA düzeyi ve biyopsi Gleason skoru arttıkça cerrahi sınır pozitifliği artmaktadır. Tedavi şekline karar vermede klinik ve patolojik ölçütler daha dikkatli değerlendirmelidir.
Introduction: Radical prostatectomy is a common therapeutic procedure applied when clinically organ confined prostate cancer is diagnosed. Unfortunately, approximately one third of patients who undergo radical prostatectomy have positive surgical margins, and these patients have increased risk of local and systemic cancer progression. The aim of this study is to determine the association between preoperative serum prostate specific antigen levels (PSA) and biopsy Gleason sum with surgical margin status in patients with prostate cancer treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Materials and Methods: In this study, 259 patients who underwent radical retropubic prostetectomy and bilateral pelvic lymphadenectomy in our clinic with the diagnosis of organ confined prostate cancer were included. All patients were evaluated by detailed medical examination, digital rectal examination, serum PSA levels, and transrectal ultrasound-guided prostate biopsy. Pelvic computerized tomography, magnetic resonance imaging and bone scan were performed as clinically indicated. The correlation of data including preoperative serum PSA levels, biopsy Gleason sum, postoperative Gleason sum, and pathologic stage with postoperative surgical margin status was examined. Fisher’s exact test was used for statistical analysis and p values < 0.05 were considered statistically significant. Results: The mean age of patients was 64.4±6.1 years (range 46-78 years), and the mean preoperative serum PSA level was 11.3±14.1 ng/ml (range 0.6-150 ng/ml). The overall positive surgical margin rate was 21.2% (55/259). Histopathological evaluation of radical retropubic prostatectomy specimens revealed that 2.6% (n=3) of patients with pT2, 26.7% (n=27) with pT3a, 50% (n=16) with pT3b, and 69.2% (n=9) with pN1 had positive surgical margin. A positive surgical margin occurred in 16.7% of patients with a preoperative serum PSA level of 10 ng/ml or less compared to 27.6% of patients with serum PSA level greater than 10 ng/ml, and this difference was statistically significant (p<0.05). Of patients with biopsy Gleason sum 7 or greater, 33.9% had a positive surgical margin compared to 17.5% with biopsy Gleason sum less than 7; this difference was also statistically significant (p<0.05). Of patients with final Gleason sum 7 or greater, 34.6% had a positive surgical margin compared to 13.6% with Gleason sum less than 7 (p<0.05). Conclusion: When biopsy Gleason sum and/or serum PSA levels increase, positive surgical margin status increases. Biopsy Gleason sum and serum PSA levels provide an estimation of the risk for positive surgical margin; thus, this information may be useful for the stratification of patients who undergo radical retropubic prostatectomy.
Introduction: Radical prostatectomy is a common therapeutic procedure applied when clinically organ confined prostate cancer is diagnosed. Unfortunately, approximately one third of patients who undergo radical prostatectomy have positive surgical margins, and these patients have increased risk of local and systemic cancer progression. The aim of this study is to determine the association between preoperative serum prostate specific antigen levels (PSA) and biopsy Gleason sum with surgical margin status in patients with prostate cancer treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Materials and Methods: In this study, 259 patients who underwent radical retropubic prostetectomy and bilateral pelvic lymphadenectomy in our clinic with the diagnosis of organ confined prostate cancer were included. All patients were evaluated by detailed medical examination, digital rectal examination, serum PSA levels, and transrectal ultrasound-guided prostate biopsy. Pelvic computerized tomography, magnetic resonance imaging and bone scan were performed as clinically indicated. The correlation of data including preoperative serum PSA levels, biopsy Gleason sum, postoperative Gleason sum, and pathologic stage with postoperative surgical margin status was examined. Fisher’s exact test was used for statistical analysis and p values < 0.05 were considered statistically significant. Results: The mean age of patients was 64.4±6.1 years (range 46-78 years), and the mean preoperative serum PSA level was 11.3±14.1 ng/ml (range 0.6-150 ng/ml). The overall positive surgical margin rate was 21.2% (55/259). Histopathological evaluation of radical retropubic prostatectomy specimens revealed that 2.6% (n=3) of patients with pT2, 26.7% (n=27) with pT3a, 50% (n=16) with pT3b, and 69.2% (n=9) with pN1 had positive surgical margin. A positive surgical margin occurred in 16.7% of patients with a preoperative serum PSA level of 10 ng/ml or less compared to 27.6% of patients with serum PSA level greater than 10 ng/ml, and this difference was statistically significant (p<0.05). Of patients with biopsy Gleason sum 7 or greater, 33.9% had a positive surgical margin compared to 17.5% with biopsy Gleason sum less than 7; this difference was also statistically significant (p<0.05). Of patients with final Gleason sum 7 or greater, 34.6% had a positive surgical margin compared to 13.6% with Gleason sum less than 7 (p<0.05). Conclusion: When biopsy Gleason sum and/or serum PSA levels increase, positive surgical margin status increases. Biopsy Gleason sum and serum PSA levels provide an estimation of the risk for positive surgical margin; thus, this information may be useful for the stratification of patients who undergo radical retropubic prostatectomy.
Açıklama
Anahtar Kelimeler
Prostat Kanseri, Prostat Spesifik Antijen, Cerrahi Sınır, Gleason Skoru, Prostate Cancer, Prostate-Specific Antigen, Surgical Magrin, Gleason Sum
Kaynak
Türk Üroloji Dergisi
Turkish Journal of Urology
Turkish Journal of Urology
WoS Q Değeri
Scopus Q Değeri
N/A
Cilt
34
Sayı
3
