Yüksek Riskli Prostat Kanserinde Radikal Prostatektomi

Year 2016, Volume: 43 Issue: 3, 419 - 423, 01.09.2016

Taha Numan Yıkılmaz Erdem Öztürk

Abstract

Amaç: Yüksek riskli prostat kanserinin tedavisinde cerrahi
ve radyoterapi seçenekleri bulunmaktadır. Günümüzde
cerrahi tecrübenin artması nedeniyle yüksek riskli gruba
da cerrahi uygulayan merkezler bulunmaktadır. Kliniğimizde
yüksek riskli prostat kanseri tanısı konulup açık
radikal prostatektomi uygulanan olguların fonksiyonel ve
onkolojik sonuçlarını değerlendirdik.
Yöntemler: Şubat 2011 ve Şubat 2015 tarihleri arasında
radikal prostatektomi uygulanan 203 olgu çalışmaya
alındı. Olguların 20 tanesinin yüksek riskli olduğu anlaşıldı.
Bu olguların demografik ve karakteristik özellikleri
retrospektif olarak toplandı. Yüksek riskli olgular ile diğer
riskteki prostat kanseri olgularının özellikleri istatistiksel
olarak karşılaştırıldı. Yüksek riskli olgularda biyokimyasal
nüks ile ilişkili parametreler incelendi.
Bulgular: Yüksek riskli prostat kanseri tanısı alan olguların
ortalama yaşı 63.1 (aralık 56-69 yaş), ortalama PSA
seviyeleri 14.2 ng/mL (aralık 9-46 ng/mL), ortalama takip
süreleri 27.85 ay şeklinde bulundu. Olguların 11‘inde
(%55) biyokimyasal nüks izlendi. Yüksek riskli olgularda
istatistiksel olarak biyokimyasal nüks ile sadece seminal
vezikül invazyonu arasında ilişki anlamlı çıkmıştır.
Sonuç: Bu bulgular neticesinde yaş, komorbidite ve hasta
tercihi göz önünde bulundurularak yüksek riskli hastalarda
cerrahi seçenek öncelikli olarak düşünülmesi gerekmektedir.
Gleason skorunun onkolojik sonuçları öngörmede
en önemli faktör olduğu ve klinik T3 evrelerin %20
kadarının organa sınırlı hastalık patolojisine sahip olabileceği
unutulmamalıdır. Onkolojik ve fonksiyonel sonuçları
bakımından yüksek risk ve düşük risk arasında anlamlı
bir fark bulunmadığı ancak hastalara cerrahi sonrası ek
tedavilerin gerekebileceği akılda tutulmalıdır.

Keywords

prostat kanseri, radikal prostatektomi, yüksek risk

Radical Prostatectomy In High-Risk Prostate Cancer

Abstract

Objective: There are some treatment choices such as surgery and radiotherapy in the treatment of high-risk prostate cancer. Today, some centers prefer surgical pro­cedures in high-risk group due to increasing surgical ex­perience. In our clinic, we evaluated the functional and oncological outcomes of patients who underwent open radical prostatectomy in high-risk prostate cancer. Methods: Data on 203 patients underwent radical prosta­tectomy between February 2011 and February 2015 were investigated. There were 20 cases in high-risk group. Characteristics and demographic datas of these patients were collected retrospectively. The characteristics of high-risk patients with other risk cases were compared statistically. Parameters associated with biochemical re­currence were examined in high-risk patients. Results: Mean age of patients was 63.1 years (range 56-69 years), the average PSA level were 14.2 ng / ml (range 9-46 ng / mL) and median follow-up was 27.85 months in high-risk prostate cancer. Biochemical recurrence was detected in 11 cases (55%). A statistically significant cor­relation was seen biochemical recurrence between semi­nal vesicle invasions in high-risk patients. Conclusion: Surgical options should be first preference in high-risk patients considering age, co-morbidity and patients choice in the result of these findings. Gleason score is the most important factor in predicting oncologi­cal outcomes and organ-confined disease may be in 20% of clinical stage T3. There is no significant difference between high risk and low risk patients in oncologic and functional outcomes but should be kept in mind additional treatment may need after surgery

Keywords

prostate cancer, radical prostatectomy, high risk

References

• 1. Meng MV, Elkin EP, Harlan SR, et al. Predictors of treatment after initial surveillance in men with prostate cancer: results from CaPSURE. J Urol. 2003;170:2279-83.
• 2. D’Amico AV, Whittington R, Malkowicz SB et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969-74.
• 3. Divrik RT. Yüksek riskli prostat kanserine yaklaşım. Üroonkoloji Bülteni 2008;7:13-9.
• 4. Bodakçi MN, Bozkurt Y, Atar M, ve ark. Düşük prostat spesifik antijen değeri olan hastalara yapılan transrektal prostat biyopsi sonuçları. Dicle Med J 2012;39:238-41
• 5. Şahin H, Deliktaş H. Yüksek riskli lokalize prostat kanserinde radikal prostatektomi endikasyonları ve sonuçları. Üroonkoloji Bülteni. 2013;12:132-6
• 6. Şahin H, Deliktaş H. Yüksek Risk Prostat Kanserinde Radikal Prostatektomi ve Lenfadenektomi: Cerrahi Teknik, Fonksiyonel ve Onkolojik Sonuçlar. Üroonkoloji Bülteni. 2015;14:113-9.
• 7. Bolla M, Collette L, Blank L, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002;360:103- 106.
• 8. Van Poppel H, Joniau S. An analyzis of radical prostatectomy in advance stage and high-grade prostate cancer. Eur Urol 2008;53:253-9.
• 9. Freedland SJ, Partin AW, Humphreys EB, et al. Radical prostatectomy for clinical stage T3a disease. Cancer. 2007;109:1273-8.
• 10. Ward JF, Slezak JM, Blute ML, et al. Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int. 2005;95:751-6.
• 11. Bolla M, van Poppel H, Tombal B, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012;380:2018-27.
• 12. Loeb S, Schaeffer EM, Trock BJ, et al. What are the outcomes of radical prostatectomy for high-risk prostate cancer? Urology. 2010;76:710-4.
• 13. Lewinshtein D, Teng B, Valencia A, et al. The long-term outcomes after radical prostatectomy of patients with pathologic Gleason 8-10 disease. Adv Urol. 2012;2012:428098.
• 14. Lau WK, Bergstralh EJ, Blute ML, et al. Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol. 2002;167:117-22.
• 15. Sweat SD, Bergstralh EJ, Slezak J, et al. Competing risk analysis after radical prostatectomy for clinically nonmetastatic prostate adenocarcinoma according to clinical Gleason score and patient age. J Urol. 2002;168:525-9.
• 16. Kane CJ, Presti JC Jr, Amling CL, et al; SEARCH Database Study Group. Changing nature of high risk patients undergoing radical prostatectomy. J Urol. 2007;177:113-7.
• 17. Yossepowitch O, Eggener SE, Bianco FJ Jr, et al Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol. 2007;178:493-9.
• 18. Eastham JA, Evans CP, Zietman A. What is the optimal management of high risk, clinically localized prostate cancer? Urol Oncol. 2010;28:557-67.
• 19. Berglund RK, Jones JS, Ulchaker JC, et al. Radical prostatectomy as primary treatment modality for locally advanced prostate cancer: a prospective analysis. Urology. 2006;67:1253-56.