A Contemporary Series on Retropubic Radical Prostatectomy and an Analysis of Factors Influencing Biochemical Recurrence-Free Survival

Öz

This study investigates outcomes and identifies factors influencing biochemical recurrence and biochemical recurrence-free survival (BRFS) rates in patients undergoing retropubic radical prostatectomy (RRP) at a tertiary university hospital over 10 years. Data of patients who underwent RRP between 2012 and 2022 were analyzed retrospectively. Variables included demographic information, preoperative prostate-specific antigen (PSA) levels, prostate volume, PSA density, operative details, histopathological findings, and postoperative follow-up data. Patients without at least three years of regular follow-up were excluded from the study. The Cox regression analyses were performed to determine the independent risk factors for BRFS. Survival analysis was performed using Kaplan-Meier and the log‐rank test. The final analysis included 115 patients. The median follow-up duration was 77.2 months (range: 36.3–153.6), and the median BRFS was 47.3 months (range: 0–153.6). The 3-year BRFS rate was 61.8%. Positive surgical margins were identified as a significant predictor of BRFS (HR: 2.388, p=0.004), while higher PSA density and the ISUP grade groups also showed associations with recurrence risk (p= 0.033 and 0.048, respectively). Survival analyses confirmed shorter BRFS in patients with positive surgical margins (p=0.000). This study highlights the effectiveness of RRP in the surgical management of localized PCA. Surgical margin status emerged as the primary predictor of BRFS. PSA density may be a promising parameter in predicting biochemical recurrence, but further studies are needed.

Anahtar Kelimeler

• Retropubic radical prostatectomy
• prostate cancer
• biochemical recurrence-free survival

Retropubik Radikal Prostatektomi Üzerine Çağdaş Bir Seri ve Biyokimyasal Nükssüz Sağkalımı Etkileyen Faktörlerin Analizi

Öz

Bu çalışmanın amacı üçüncü basamak sağlık hizmeti veren bir üniversite hastanesinde son 10 yılda yapılan retropubik radikal prostatektomi (RRP) ameliyatlarının sonuçlarını değerlendirmek ve cerrahi tedavi alan hastalarda biyokimyasal nüksüz sağkalımı (BNS) etkileyen faktörleri belirlemektir. Bu çalışma için kliniğimizde 2012-2022 yılları arasında RRP geçiren hastaların verilerini retrospektif olarak analiz edildi. İncelenen veriler arasında; hastaların demografik bilgileri, preoperatif prostat spesifik antijen (PSA) düzeyi, prostat hacmi, PSA dansitesi, operatif veriler, histopatolojik sonuçlar ve postoperatif takip bilgileri mevcuttu. En az üç yıllık düzenli takibi olmayan hastalar çalışma dışı bırakıldı. BNS üzerine etki eden faktörleri belirlemek için Cox regresyon analizi uygulandı. Sağkalım analizi log-rank testi uygulanarak Kaplan-Meier grafi ile verildi. Analize 115 hasta dahil edildi. Medyan takip süresi 77,2 ay (36,3–153,6) ve medyan BNS 47,3 aydı (0–153,6). 3 yıllık BNS oranı 61.8%’ olarak bulundu. Cerrahi sınır pozitifliği BNS etkileyen önemli bir faktör olarak tespit edildi (HR: 2.388, p=0.004). Ayrıca yüksek PSA dansitesi ve yüksek ISUP derece grup varlığı biyokimyasal rekürrens ile ilişkili bulunmuştur (p sırasıyla = 0,033 ve 0,048). Sağkalım analizi cerrahi sınırı pozitif olan hastaların daha kısa BNS süresine sahip olduklarını göstermiştir. (p=0.000). Bu çalışa RRP’ nin lokalize prostat kanseri tedavisindeki yerini vurgulamıştır. Cerrahi sınır durumu BNS’ yi öngörmede anlamlı bir parametredir. PSA dansitesi biyokimyasal rekürrensi öngörmede umut vaat eden bir parametredir; ancak bu konuda daha ileri çalışmalara gereksinim vardır.

Anahtar Kelimeler

• Retropubik radikal prostatektomi
• prostat kanseri
• biyokimyasal rekürrenssiz sağkalım

Kaynakça

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