Publication: Radikal retropubik prostatektomi yapılan hastalarda kapsül dışı yayılım, seminal vezikül tutulumu ve lenf nodu pozitifliği için önemli preoperatif faktörler
Abstract
Radikal retropubik prostatektomi (RRP) olgularında prostat kanseri için kullanılan tanısal tetkiklerin sonuçları klinisyene operasyon sonrası hastalığın durumu ve yaygınlığı hakkında bilgi verebilmektedir. Bu çalışmanın amacı RRP'li olgularda operasyon öncesi yapılan tetkiklerin hastalığın yaygınlık derecesini göstermedeki öngörü değerini saptamaktır. Klinik olarak organa sınırlı prostat kanseri nedeniyle RRP operasyonu geçiren ve izlemlerinde yeterli bilgi saptanabilen 157 hastanın verileri geriye dönük olarak incelendi. Hastaların operasyon öncesi serum PSA değeri, transrektal ultrasonografide (TRUS) saptanan lokal yayılım derecesi ve TRUS biyopsi sonrası elde edilen Gleason skoru ile postoperatif patolojik inceleme sonucu saptanan ekstrakapsüler yayılım (EK), seminal vezikül invazyonu (SV), lenf nodu tutulumu(LN) ve cerrahi sınır (CS) pozitifliği bulgularının ilişkisi araştırıldı. Hastaların operasyon öncesi serum PSA değeri ortalama (mean) 11,8 (ortanca 8,7) ng/ml. olarak saptandı. RRP sonrası yapılan patolojik incelemede 61 (%39) hastada EK yayılım, 36 (%23) hastada SV tutulumu, 7 (%0,5) hastada LN tutulumu ve 53 (%34) hastada CS pozitifliği saptandı.Ameliyat sonrası patoloji bulguları ile TRUS bulgularının karşılaştırılmasında TRUS'un EK yayılımı saptamada duyarlılığı %15,4 ve özgüllüğü %94,7 olarak bulunurken SV tutulumunu saptamada duyarlılığı %12,9 ve özgüllüğü % 97,9 olarak bulundu. EK tutulum saptanan olguların ortanca serum PSA değeri 9 ng/ml. ve TRUS biyopside ortanca Gleason skoru 7 olarak saptanırken, EK tutulum saptanmayan olguların ortanca serum PSA değeri 6,5 ng/ml. (p<0,05) ve TRUS biyopside ortanca Gleason skoru 6 (p<0,05) olarak bulundu. SV tutulumu görülen olguların ortanca serum PSA değeri 9,7 ng/ml. ve ortanca Gleason skoru 7 olarak bulunurken, SV tutulumu görülmeyen hastaların ortanca seram PSA değeri 5,4 ng/ml. (p<0,05) ve ortanca Gleason skoru 6 (p<0,05) olarak saptandı. LN tutulumu olan hastaların ortanca serum PSA değeri 15,1 ng/ml ve ortanca Gleason skoru 8 iken, LN tutulumu olmayan grubun ortanca serum PSA değeri 8,6 ng/ml (p<0,05) ve ortanca Gleason skoru 6 (p<0,05) olarak gözlendi. CS pozitifliği (Tablo 4) saptanan olgularda da ortanca serum PSA değeri 14,7 ng/ml ve TRUS-biyopsi ortanca Gleason skoru 7 olarak saptanırken CS pozitifliği saptanmayan olgularda ortanca serum PSA değeri 14,2 ng/ml (p<0.05) ve TRUS-biyopsi ortanca Gleason skoru 6 (p<0.05) olarak bulundu. RRP sonrası prostat dışı hastalığı öngörmede Gleason skoru ve serum PSA düzeyi en önemli parametre olarak saptanmıştır.
Introduction: Initial diagnostic evaluation may provide information about the extent of disease after radical retropubic prostatectomy (RRP). The aim of this study is to investigate the predictive value of various diagnostic studies in determining the extent of disease in radical retropubic prostatectomy specimens. Material and Methods: A retrospective analysis was performed for 157 patients who underwent RRP for organ confined prostate cancer and whose follow-up data was accessible. The correlation of preoperative serum PSA level, local disease extension in TRUS, and Gleason score at TRUS biopsy specimen with postoperative extracapsular extension (EC), seminal vesicle invasion (SV), lymph node involvement (LN) and surgical margin status (SM) on RRP specimens were statistically analyzed. Results: The mean preoperative serum PSA level of all patients was 11.8 (median 8.72) ng/ml. After the evaluation of RRP specimens, 61 (39%) patients were found to have EC extension, 36 (%23) patients had SV invasion, 7 (0.5%) had LN involvement, and 53 (%34) had positive surgical margin(s). Comparing the preoperative TRUS findings and postoperative evaluation of RRP specimens, the sensitivity of TRUS in predicting the EC extension was 15.4% and specificity was 94.7%. Sensitivity of TRUS in predicting SV invasion was 12.9% and its specificity was 97.9%. The median PSA level was 9 ng/ml. and median Gleason score in TRUS biopsy was 7 in patients with EC extension while median serum PSA level was 6.5 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without any EC extension. The median serum PSA level was 9.7 ng/ml and median Gleason score was 7.0 in patients with SV invasion while median serum PSA level was 5.4 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without SV invasion. The median PSA level was 15.1 ng/ml and Gleason score was 8.0 in patients with LN involvement while median PSA level was 8.6 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without LN involvement. The median PSA level was 14.7 ng/ml and Gleason score was 7.0 in patients with positive SM while median PSA level was 14.2 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without positive SM. Conclusions: Gleason score and serum PSA level appears to be the most important predictive factors for extraprostatic disease in RRP specimens.
Introduction: Initial diagnostic evaluation may provide information about the extent of disease after radical retropubic prostatectomy (RRP). The aim of this study is to investigate the predictive value of various diagnostic studies in determining the extent of disease in radical retropubic prostatectomy specimens. Material and Methods: A retrospective analysis was performed for 157 patients who underwent RRP for organ confined prostate cancer and whose follow-up data was accessible. The correlation of preoperative serum PSA level, local disease extension in TRUS, and Gleason score at TRUS biopsy specimen with postoperative extracapsular extension (EC), seminal vesicle invasion (SV), lymph node involvement (LN) and surgical margin status (SM) on RRP specimens were statistically analyzed. Results: The mean preoperative serum PSA level of all patients was 11.8 (median 8.72) ng/ml. After the evaluation of RRP specimens, 61 (39%) patients were found to have EC extension, 36 (%23) patients had SV invasion, 7 (0.5%) had LN involvement, and 53 (%34) had positive surgical margin(s). Comparing the preoperative TRUS findings and postoperative evaluation of RRP specimens, the sensitivity of TRUS in predicting the EC extension was 15.4% and specificity was 94.7%. Sensitivity of TRUS in predicting SV invasion was 12.9% and its specificity was 97.9%. The median PSA level was 9 ng/ml. and median Gleason score in TRUS biopsy was 7 in patients with EC extension while median serum PSA level was 6.5 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without any EC extension. The median serum PSA level was 9.7 ng/ml and median Gleason score was 7.0 in patients with SV invasion while median serum PSA level was 5.4 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without SV invasion. The median PSA level was 15.1 ng/ml and Gleason score was 8.0 in patients with LN involvement while median PSA level was 8.6 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without LN involvement. The median PSA level was 14.7 ng/ml and Gleason score was 7.0 in patients with positive SM while median PSA level was 14.2 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without positive SM. Conclusions: Gleason score and serum PSA level appears to be the most important predictive factors for extraprostatic disease in RRP specimens.