Araştırma Makalesi
BibTex RIS Kaynak Göster

Radikal prostatektomi yapılmış intermediate risk prostat kanseri hastalarında postoperatif sonuçların karşılaştırılması

Yıl 2020, Cilt: 12 Sayı: 2, 108 - 113, 23.07.2020

Öz

Amaç:
Prostat kanseri erkeklerde en sık görülen malignitelerdendir. En uygun tedavi rejimini belirlemek için düşük, orta ve yüksek risk olarak sınıflara ayrılmaktadır. Orta(intermediate) risk prostat kanserinin tedavisi, bu sınıflandırma kapsamına giren hastaların heterojenitesinden dolayı tartışmalıdır. Son yıllarda bu hastalar daha iyi prognoz beklenen 'Favourable' ve daha kötü prognoz beklenen 'Unfavourable' grup olarak 2'ye ayrılmıştır. Intermediate risk prostat kanserinde tedavide aktif izlem, radikal prostatektomi ve radyoterapi seçenekleri mevcuttur.

Materyal-Metod:
2016-2020 yılları arasında kliniğimizde prostat kanseri nedeniyle radikal prostatektomi yapılan intermediate risk grubundaki 36 hastayı retrospektif olarak değerlendirdik. Hastaları risk faktörlerine göre favourable ve unfavourable olmak üzere iki gruba ayırdık. Hastaların preoperatif prostat biyopsi ve radikal prostatektomi patoloji sonuçlarını, postop 3. ve 6. ay kontrol PSA sonuçlarını, cerrahi sınır pozitiflik oranlarını, klinik ve patolojik evreler arasındaki farkları SPSS programını kullanarak istatistiki olarak karşılaştırdık.

Sonuç:
Pozitif kor sayısı, postop 3. ve 6. ay PSA değerleri, pozitif kor sayısı, cerrahi sınır pozitifliği, radikal prostatektomi sonrası upstage olma oranının unfavourable grupta daha yüksek olduğu tespit edildi. Bu farklar istatistiksel olarak anlamlı değildi. Pozitif kor yüzdesi ise unfavourabla grupta istatistiksel olarak anlamlı şekilde daha yüksekti.(P<0,001)

Tartışma:
İntermediate risk prostat kanseri heterojen bir hastalık grubudur. Tedavi rejimleri belirlenirken yaş, ek hastalık, hasta beklentisi gibi faktörler göz önünde bulundurularak seçim yapılması önem arzetmektedir.

Kaynakça

  • 1. Siegel R, Ma J, Zou Z, et al. Cancerstatistics. CA Cancer J Clin 2014; 64:9–29.
  • 2. National Comprehensive Cancer Network NCCN clinical practice guidelines in oncology: prostate cancer 2019.
  • 3. Grossfeld GD, Latini DM, Lubeck DP, Mehta SS, Carroll PR. Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol. 2003; 169:157-63.
  • 4. D’Amico AV. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280:969.
  • 5. Jung J-W, Lee JK, Hong SK, Byun S-S, Lee SE. Stratifcation of patients with intermediate-risk prostate cancer. BJU Int. 2015; 115:907–12.
  • 6. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/ SUO guideline. Part I: risk stratifcation, shared decision making, and care options. J Urol. 2018; 199:683-90.
  • 7. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62:10–29.
  • 8. Zumsteg ZS, Chen Z, Howard LE, et al. Number of unfavorable intermediate-risk factors predicts pathologic upstaging and prostate cancer-specific mortality following radical prostatectomy: results from the SEARCH database. Prostate 2017; 77:154–63.
  • 9. Mottet N, van den Bergh RCN, Briers E, et al. EAU – ESTRO – ESUR – SIOG guidelines on prostate cancer. 2019.
  • 10. Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2019; 17:479–505.
  • 11. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016; 375:1415–24.
  • 12. Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015; 33:272–7.
  • 13. Stewart SB, Boorjian SA. Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol 2015; 33:235-244
  • 14. Sanda Martin G, Cadeddu Jeffrey A, Erin Kirkby, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 2018; 199:683–90.
  • 15. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N Engl J Med 2018; 379:2319-29.
  • 16. Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017; 377:132-42.
  • 17. Wallis CJD, Saskin R, Choo R, et al. Surgery versus radiotherapy for clinically-localized prostate cancer: a systematic review and metaanalysis. Eur Urol 2016; 70:21–30.
  • 18. Hoffman KE, Voong KR, Levy LB, et al. Randomized trial of hypo- fractionated, dose-escalated, intensity-modulated radiation therapy (IMRT) versus conventionally fractionated IMRT for localized prostate cancer. J Clin Oncol 2018; 36:2943-9.
  • 19. Chua S, Qureshi MM, Boyd G, Gignac GA, Hirsch AE. Outcomes for Young Men With Localized Intermediate-Risk Prostate Cancer: An Analysis of the NCDB. Clin Genitourin Cancer. 2020 Feb 22. pii: S1558-7673(20) 30036-7.

Comparison of postoperative results in intermediate risk prostate cancer patients with radical prostatectomy

Yıl 2020, Cilt: 12 Sayı: 2, 108 - 113, 23.07.2020

Öz

Objective:
Prostate cancer is one of the most common malignities in males. It is separated into low, intermediate and high risk groups to determine the most suitable treatment regimen. Treatment of average risk prostate cancer is controversial due to the heterogeneity of the patients included in this classification. In recent years, these patients were separated into two groups as 'Favourable' in which a better prognosis is expected and as 'Unfavourable' in which a worse prognosis is expected. Active surveillance, radical prostatectomy and radiotherapy are the available options for intermediate risk prostate cancer.

Material and Method:
We retrospectively evaluated 36 patients in intermediate risk group who had radical prostatectomy in our clinic due to prostate cancer between 2016 and 2020. We separated the patients into two groups as favourable and unfavourable based on risk factors.
We statistically compared preoperative prostate biopsy and radical prostatectomy pathology results, postop 3 and 6 month control PSA results, surgical border positivity ratios and the differences between clinical and pathological stages of the patients using SPSS program.

Results:
Positive core number, post op. 3rd and 6th month PSA values, positive core count, surgical border positivity, post radical protatectomy upstaging ratio were detected higher in unfavourable group. These differences were statistically insignificant. Positive core percentage was statistically significantly higher in unfavourable group (P<0.001).

Conclusion:
Intermediate risk prostate cancer is a heterogeneous disease group. Treatment regimens should be selected by considering factors such as age, additional disease and patient expectation.

Kaynakça

  • 1. Siegel R, Ma J, Zou Z, et al. Cancerstatistics. CA Cancer J Clin 2014; 64:9–29.
  • 2. National Comprehensive Cancer Network NCCN clinical practice guidelines in oncology: prostate cancer 2019.
  • 3. Grossfeld GD, Latini DM, Lubeck DP, Mehta SS, Carroll PR. Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol. 2003; 169:157-63.
  • 4. D’Amico AV. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280:969.
  • 5. Jung J-W, Lee JK, Hong SK, Byun S-S, Lee SE. Stratifcation of patients with intermediate-risk prostate cancer. BJU Int. 2015; 115:907–12.
  • 6. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/ SUO guideline. Part I: risk stratifcation, shared decision making, and care options. J Urol. 2018; 199:683-90.
  • 7. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62:10–29.
  • 8. Zumsteg ZS, Chen Z, Howard LE, et al. Number of unfavorable intermediate-risk factors predicts pathologic upstaging and prostate cancer-specific mortality following radical prostatectomy: results from the SEARCH database. Prostate 2017; 77:154–63.
  • 9. Mottet N, van den Bergh RCN, Briers E, et al. EAU – ESTRO – ESUR – SIOG guidelines on prostate cancer. 2019.
  • 10. Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2019; 17:479–505.
  • 11. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016; 375:1415–24.
  • 12. Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015; 33:272–7.
  • 13. Stewart SB, Boorjian SA. Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol 2015; 33:235-244
  • 14. Sanda Martin G, Cadeddu Jeffrey A, Erin Kirkby, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 2018; 199:683–90.
  • 15. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N Engl J Med 2018; 379:2319-29.
  • 16. Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017; 377:132-42.
  • 17. Wallis CJD, Saskin R, Choo R, et al. Surgery versus radiotherapy for clinically-localized prostate cancer: a systematic review and metaanalysis. Eur Urol 2016; 70:21–30.
  • 18. Hoffman KE, Voong KR, Levy LB, et al. Randomized trial of hypo- fractionated, dose-escalated, intensity-modulated radiation therapy (IMRT) versus conventionally fractionated IMRT for localized prostate cancer. J Clin Oncol 2018; 36:2943-9.
  • 19. Chua S, Qureshi MM, Boyd G, Gignac GA, Hirsch AE. Outcomes for Young Men With Localized Intermediate-Risk Prostate Cancer: An Analysis of the NCDB. Clin Genitourin Cancer. 2020 Feb 22. pii: S1558-7673(20) 30036-7.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Üroloji
Bölüm Araştırma Makaleleri
Yazarlar

Arif Aydın 0000-0001-8691-090X

Gökhan Ecer 0000-0002-2805-8664

Muzaffer Kılınç Bu kişi benim 0000-0002-1024-3394

Mehmet Balasar Bu kişi benim 0000-0003-4041-9669

Nurullah Altınkaya Bu kişi benim 0000-0003-4846-398X

Hakan Taşkapu Bu kişi benim 0000-0002-2916-0177

Mehmet Giray Sönmez 0000-0003-4615-7348

Yayımlanma Tarihi 23 Temmuz 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 12 Sayı: 2

Kaynak Göster

Vancouver Aydın A, Ecer G, Kılınç M, Balasar M, Altınkaya N, Taşkapu H, Sönmez MG. Comparison of postoperative results in intermediate risk prostate cancer patients with radical prostatectomy. Endourol Bull. 2020;12(2):108-13.