Scheepe J R, Vis A N, Mickisch G H
Department of Urology, University Hospital Erasmus MC, Rotterdam, The Netherlands.
Onkologie. 2003 Aug;26(4):330-3. doi: 10.1159/000072090.
Some patients from our radical prostatectomy (RPx) series with organ-confined (pT2) prostate cancer and negative surgical margins show a PSA (prostate specific antigen) relapse. Aim of the study was to analyze this cohort of patients that otherwise would have been considered to be cured.
Since the introduction of PSA measurement in the follow-up after RPx, 475 pelvic lymph node dissections with subsequent RPx were performed in our department from 1988 to 1997. Of these, 227 were classified as pT2, 34 (15%) exhibited positive surgical margins, and 4 others were excluded due to an inadequate follow-up. Of the remaining 189 patients (study cohort), 19 (10%) developed a biochemical progression, defined as a minimum of 2 consecutive PSA measurements > or = 0.1 ng/ml. Only in one of them a G3 tumor was present. Median follow-up was 19.1 months.
The Kaplan-Meier analysis of biochemical progression showed that after 1, 2 and 5 years, 95% (confidence interval (Cl) 91-99%), 91% (Cl 86-96%), and 77% (Cl 55-89%) of the patients were free of progression, respectively. This means that roughly one fourth of pT2 tumors will become progressive despite negative surgical margins. These 19 patients were subdivided into 4 groups: 1: biopsy-proven local recurrence (n = 2); 2: suspected local recurrence defined as slowly rising PSA < or = 2 ng/ml, but negative biopsies (n = 12); 3: distant metastasis proven by radiologic imaging (n = 1); 4: suspected distant metastasis defined as rapidly rising PSA > 9 ng/ml without direct radiologic evidence (n = 4). Preoperatively all patients from groups 3 + 4 had negative bone scans and 4/5 had preoperative PSA values < 10 ng/ml. In total 7 patients with proven recurrence or with proven metastasis had positive biopsies.
A pathological diagnosis of organ-confined prostate cancer (pT2) and a meticulous analysis of negative surgical margins do not exclude the occurrence of local relapses in 7% (14/189), and there is evidence for suspect hematogenic spread of PC cells in at least 2% (4/189) of patients.
在我们的根治性前列腺切除术（RPx）系列中，一些患有器官局限性（pT2）前列腺癌且手术切缘阴性的患者出现了前列腺特异性抗原（PSA）复发。本研究的目的是分析这组原本被认为已治愈的患者。
自RPx术后随访中引入PSA检测以来，1988年至1997年我们科室共进行了475例盆腔淋巴结清扫术及后续的RPx手术。其中，227例被分类为pT2，34例（15%）手术切缘阳性，另有4例因随访不充分被排除。在其余189例患者（研究队列）中，19例（10%）出现了生化进展，定义为至少连续2次PSA测量值≥0.1 ng/ml。其中只有1例存在G3肿瘤。中位随访时间为19.1个月。
生化进展的Kaplan-Meier分析显示，1年、2年和5年后，分别有95%（置信区间（Cl）91 - 99%）、91%（Cl 86 - 96%）和77%（Cl 55 - 89%）的患者无进展。这意味着尽管手术切缘阴性，约四分之一的pT2肿瘤仍会进展。这19例患者被分为4组：1：活检证实的局部复发（n = 2）；2：疑似局部复发，定义为PSA缓慢升高≤2 ng/ml但活检阴性（n = 12）；3：经影像学检查证实的远处转移（n = 1）；4：疑似远处转移，定义为PSA快速升高>9 ng/ml且无直接影像学证据（n = 4）。术前3 + 4组的所有患者骨扫描均为阴性，4/5患者术前PSA值<10 ng/ml。总共有7例复发或转移证实的患者活检为阳性。
器官局限性前列腺癌（pT2）的病理诊断及对阴性手术切缘的细致分析并不能排除7%（14/189）的患者出现局部复发，并且有证据表明至少2%（4/189）的患者存在PC细胞疑似血行播散。
