Stimac Goran, Dimanovski Jordan, Trnski Davor, Katusić Josip, Ruzić Boris, Spajić Borislav, Reljić Ante, Padovan Milko, Kraus Ognjen
Department of Urology, University Hospital "Sestre milosrdnice", Zagreb, Croatia.
Coll Antropol. 2007 Dec;31(4):1055-60.
We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period. We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ-confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ-confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted.
我们展示了在我们科室接受耻骨后根治性前列腺切除术（RRP）治疗的临床局限性前列腺癌（PC）患者的临床表现和治疗结果的演变，强调了这10年间变化的流行病学意义。我们评估了患者年龄、术前前列腺特异性抗原（PSA）、术前与术后分期及 Gleason 分级、器官局限性状态和手术切缘状态的年度变化趋势。1996年1月至2005年12月共进行了488例RRP手术，年手术例数从8例增加到129例（增长了1512.5%）。2005年患者平均年龄从61.5岁增至66.12岁，70岁以上男性的比例分别从12.5%增至26.5%。仅基于病理PSA水平（作为前列腺活检指征）检测出的PC显著上升，从25.5%升至70%，术后器官局限性疾病的发生率也从25%显著增至74.7%。术前平均PSA从16.7降至9.89 ng/mL。相反，术前PSA值在4至10 ng/mL之间的患者比例有所增加（从20%增至65.4%）。手术切缘阳性率从49.4%降至25%，接受新辅助治疗的患者比例从78.5%降至5.4%。分级过低的患者比例从75.1%降至31.7%。分期过低的发生率多年来一直相对稳定。在研究期间，基于仅病理PSA水平通过前列腺活检越来越多地检测出PC，并且由于术前对临床分期的评估更准确、新辅助治疗的使用减少以及手术技术的改进，显著转向了更多器官局限性分期，病理变量的结果更有利。我们的数据也有力地表明，应扩大而非限制常规PSA检测。
