Rausch S, Schmitt C, Kälble T
Department of Urology, Fulda Civic Hospital, Pacelliallee 4, 36043 Fulda, Germany.
Adv Urol. 2012;2012:410246. doi: 10.1155/2012/410246. Epub 2011 Oct 11.
Introduction. High-risk prostate cancer represents a therapeutic challenge. The role of radical prostatectomy (RP) in patients with extreme PSA values is under discussion. Material and Methods. We retrospectively analysed our data of 56 consecutive patients with preoperative PSA ≥ 40 mg/mL undergoing open radical retropubic prostatectomy from 1999 to 2009. Patient survival and time to PSA recurrence were recorded, and the Kaplan-Meier survival analysis was performed. Postoperative quality of life and functional status were investigated using a SF-12 questionnaire and determining the number of pads used per day. Results. Overall 56 patients were available for followup after a median time of 83.84 months. Locally advanced carcinoma was present in 84% while 16% of patients had organ-confined stages. A positive nodal status was observed in 46%. Overall survival was 95% at five and 81% at 10 years. Cancer-specific survival was 100% for five years and 83% for 10 years. Corresponding biochemical recurrence-free survival was low (52% and 11%, resp.). Quality of life and functional outcomes were favourable. Conclusions. In patients with PSA ≥ 40 mg/mL, RP allows long-term control, exact planning of adjuvant treatment, and identification of curable disease.
引言。高危前列腺癌是一项治疗挑战。根治性前列腺切除术（RP）在前列腺特异抗原（PSA）值极高的患者中的作用仍在讨论中。
材料与方法。我们回顾性分析了1999年至2009年间连续56例术前PSA≥40mg/mL并接受开放性耻骨后根治性前列腺切除术患者的数据。记录患者生存率和PSA复发时间，并进行Kaplan-Meier生存分析。使用SF-12问卷并确定每日使用尿垫数量来调查术后生活质量和功能状态。
结果。中位随访时间83.84个月后，共有56例患者可供随访。84%的患者存在局部晚期癌，16%的患者处于器官局限性阶段。46%的患者出现淋巴结阳性状态。5年总生存率为95%，10年为81%。癌症特异性生存率5年为100%，10年为83%。相应的无生化复发生存率较低（分别为52%和11%）。生活质量和功能结果良好。
结论。对于PSA≥40mg/mL的患者，根治性前列腺切除术可实现长期控制、辅助治疗的精确规划以及可治愈疾病的识别。
