Viney R, Gommersall L, Zeif J, Hayne D, Shah Z H, Doherty A
Department of Urology, Queen Elizabeth Hospital, Birmingham, UK.
Ann R Coll Surg Engl. 2009 Jul;91(5):399-403. doi: 10.1308/003588409X428289. Epub 2009 Apr 30.
Radical retropubic prostatectomy (RRP) performed laparoscopically is a popular treatment with curative intent for organ-confined prostate cancer. After surgery, prostate specific antigen (PSA) levels drop to low levels which can be measured with ultrasensitive assays. This has been described in the literature for open RRP but not for laparoscopic RRP. This paper describes PSA changes in the first 300 consecutive patients undergoing non-robotic laparoscopic RRP by a single surgeon.
To use ultrasensitive PSA (uPSA) assays to measure a PSA nadir in patients having laparoscopic radical prostatectomy below levels recorded by standard assays. The aim was to use uPSA nadir at 3 months' post-prostatectomy as an early surrogate end-point of oncological outcome. In so doing, laparoscopic oncological outcomes could then be compared with published results from other open radical prostatectomy series with similar end-points. Furthermore, this end-point could be used in the assessment of the surgeon's learning curve.
Prospective, comprehensive, demographic, clinical, biochemical and operative data were collected from all patients undergoing non-robotic laparoscopic RRP. We present data from the first 300 consecutive patients undergoing laparoscopic RRP by a single surgeon. uPSA was measured every 3 months post surgery.
Median follow-up was 29 months (minimum 3 months). The likelihood of reaching a uPSA of < or = 0.01 ng/ml at 3 months is 73% for the first 100 patients. This is statistically lower when compared with 83% (P < 0.05) for the second 100 patients and 80% for the third 100 patients (P < 0.05). Overall, 84% of patients with pT2 disease and 66% patients with pT3 disease had a uPSA of < or = 0.01 ng/ml at 3 months. Pre-operative PSA, PSA density and Gleason score were not correlated with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months. Positive margins correlate with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months but operative time and tumour volume do not (P < 0.05). Attempt at nerve sparing had no adverse effect on achieving a uPSA of < or = 0.01 ng/ml at 3 months.
uPSA can be used as an early end-point in the analysis of oncological outcomes after radical prostatectomy. It is one of many measures that can be used in calculating a surgeon's learning curve for laparoscopic radical prostatectomy and in bench-marking performance. With experience, a surgeon can achieve in excess of an 80% chance of obtaining a uPSA nadir of < or = 0.01 ng/ml at 3 months after laparoscopic RRP for a British population. This is equivalent to most published open series.
腹腔镜下耻骨后根治性前列腺切除术（RRP）是一种针对局限性前列腺癌的常用根治性治疗方法。手术后，前列腺特异性抗原（PSA）水平会降至低水平，可通过超灵敏检测法进行测量。这在开放性RRP的文献中有描述，但腹腔镜RRP的相关情况尚未见报道。本文描述了由一位外科医生连续进行非机器人腹腔镜RRP的前300例患者的PSA变化情况。
使用超灵敏PSA（uPSA）检测法测量接受腹腔镜根治性前列腺切除术患者的PSA最低点，该值低于标准检测法记录的水平。目的是将前列腺切除术后3个月时的uPSA最低点作为肿瘤学结局的早期替代终点。这样一来，就可以将腹腔镜肿瘤学结局与其他具有相似终点的开放性根治性前列腺切除术系列的已发表结果进行比较。此外，该终点可用于评估外科医生的学习曲线。
收集了所有接受非机器人腹腔镜RRP患者的前瞻性、全面的人口统计学、临床、生化和手术数据。我们展示了由一位外科医生连续进行腹腔镜RRP的前300例患者的数据。术后每3个月测量一次uPSA。
中位随访时间为29个月（最短3个月）。前100例患者在3个月时uPSA≤0.01 ng/ml的可能性为73%。与后100例患者的83%（P<0.05）以及第3个100例患者的80%（P<0.05）相比，该比例在统计学上较低。总体而言，84%的pT2期疾病患者和66%的pT3期疾病患者在3个月时uPSA≤0.01 ng/ml。术前PSA、PSA密度和Gleason评分与3个月时uPSA≤0.01 ng/ml所确定的结局无关。切缘阳性与3个月时uPSA≤0.01 ng/ml所确定的结局相关，但手术时间和肿瘤体积则无关（P<0.05）。保留神经的尝试对3个月时uPSA≤0.01 ng/ml的达成没有不良影响。
uPSA可作为根治性前列腺切除术后肿瘤学结局分析的早期终点。它是可用于计算外科医生腹腔镜根治性前列腺切除术学习曲线和评估手术表现的众多指标之一。通过积累经验，对于英国人群，外科医生在腹腔镜RRP术后3个月获得uPSA最低点≤0.01 ng/ml的机会可超过80%。这与大多数已发表的开放性系列研究结果相当。
