Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA.
J Endourol. 2010 Mar;24(3):403-7. doi: 10.1089/end.2009.0203.
Preoperative determination of pathologic outcomes in patients with high-risk prostate cancer is challenging because of limitations of existing nomograms. We aimed to assess whether certain preoperative clinical and pathologic characteristics correlate with pathologic outcome in high-risk prostate cancer patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP).
A retrospective evaluation of patients with high-risk disease (prostate-specific antigen [PSA] >or=10 ng/dL with high volume disease or Gleason score >or=8) who underwent RALP between December 2004 and September 2008 was conducted. Patients were grouped based on favorable pathology, including organ-confined disease and negative surgical margins (group 1), and unfavorable pathology, including positive surgical margins and extracapsular extension (group 2). Preoperative PSA levels, transrectal ultrasonography findings, and biopsy reports were compared to final pathology data.
Of 69 high-risk patients, 37 (54%) had favorable postoperative pathology (group 1) and 32 (46%) had unfavorable pathology (group 2). Mean PSA was 10.0 ng/dL (range, 4.1-20.3) (group 1) and 13.8 ng/dL (range, 3.1-39.9) (group 2). Mean PSA density was 0.28 (group 1) and 0.41 (group 2). Mean positive biopsy core was 33% (group 1) and 44% (group 2). Differences in PSA levels, PSA density, and percentage of positive cores were statistically significant (p < 0.05) between the groups. Bilateral disease and high-grade prostatic intraepithelial neoplasia were not statistically significant (p > 0.05).
Lower PSA level and PSA density, as well as fewer positive biopsy cores, were associated with favorable postoperative pathology. Continued surveillance of these patients will serve to determine whether these findings will assist in predicting which high-risk prostate cancer patients may likely benefit from RALP.
由于现有列线图的局限性，对于高危前列腺癌患者，术前确定病理结果具有挑战性。我们旨在评估在接受机器人辅助腹腔镜前列腺癌根治术（RALP）的高危前列腺癌患者中，某些术前临床和病理特征是否与病理结果相关。
对 2004 年 12 月至 2008 年 9 月期间接受 RALP 的高危疾病（前列腺特异性抗原[PSA]≥10ng/dL 且肿瘤体积大或 Gleason 评分≥8）患者进行回顾性评估。根据有利的病理结果将患者分组，包括器官局限性疾病和阴性切缘（第 1 组）和不利的病理结果，包括阳性切缘和包膜外延伸（第 2 组）。将术前 PSA 水平、经直肠超声检查结果和活检报告与最终病理数据进行比较。
在 69 例高危患者中，37 例（54%）有良好的术后病理结果（第 1 组），32 例（46%）有不良的病理结果（第 2 组）。平均 PSA 为 10.0ng/dL（范围，4.1-20.3）（第 1 组）和 13.8ng/dL（范围，3.1-39.9）（第 2 组）。平均 PSA 密度为 0.28（第 1 组）和 0.41（第 2 组）。阳性活检核心的平均百分比为 33%（第 1 组）和 44%（第 2 组）。组间 PSA 水平、PSA 密度和阳性核心百分比差异有统计学意义（p<0.05）。双侧疾病和高级前列腺上皮内瘤变无统计学意义（p>0.05）。
较低的 PSA 水平和 PSA 密度，以及较少的阳性活检核心与术后有利的病理结果相关。对这些患者的持续监测将有助于确定这些发现是否有助于预测哪些高危前列腺癌患者可能受益于 RALP。
