Bishara S, Vasdev N, Lane T, Boustead G, Adshead J
Department of Urology, Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK.
Prostate Cancer. 2014;2014:763863. doi: 10.1155/2014/763863. Epub 2014 Dec 15.
Objectives. The aims of this study were to compare the outcomes of robotic assisted laparoscopic prostatectomy (RALP) between patients who had larger (≥75 g) and smaller (<75 g) prostates and to evaluate the performance of PSA density (PSAD) in determining the oncological outcome of surgery. Methods and Materials. 344 patients who underwent RALP at a single institution were included in the study. Preoperative risk factors and postoperative, oncological outcomes, erectile function, and continence status were recorded prospectively. Results. During a mean follow-up of 20 months, biochemical recurrence (PSA > 0.2) was observed in 15 patients (4.3%). Prostate size ≥75 g was associated with lower Gleason score on final pathology (P = 0.004) and lower pathological stage (P = 0.02) but an increased length of hospital stay (P = 0.05). PSAD on binary logistic regression independently predicted biochemical recurrence (BCR) when defined as postoperative PSA >0.1 (P = 0.001) and PSA >0.2 (P = 0.039). In both instances PSA was no longer a significant independent predictor. Conclusions. RALP in large prostates (≥75 g, <150 g) is as safe as RALP in smaller prostates and is associated with a lower pathological grade and stage. Higher PSAD is independently associated with BCR and is superior to PSA as a predictor of BCR after RALP.
目的。本研究的目的是比较前列腺较大（≥75克）和较小（<75克）的患者接受机器人辅助腹腔镜前列腺切除术（RALP）的结果，并评估前列腺特异抗原密度（PSAD）在确定手术肿瘤学结果方面的性能。方法和材料。本研究纳入了在单一机构接受RALP的344例患者。前瞻性记录术前危险因素以及术后肿瘤学结果、勃起功能和控尿状态。结果。在平均20个月的随访期间，15例患者（4.3%）出现生化复发（PSA>0.2）。前列腺大小≥75克与最终病理检查时较低的Gleason评分（P = 0.004）和较低的病理分期（P = 0.02）相关，但住院时间延长（P = 0.05）。当将生化复发（BCR）定义为术后PSA>0.1（P = 0.001）和PSA>0.2（P = 0.039）时，二元逻辑回归分析显示PSAD可独立预测BCR。在这两种情况下，PSA不再是显著的独立预测因素。结论。大前列腺（≥75克，<150克）患者接受RALP与小前列腺患者接受RALP一样安全，且病理分级和分期较低。较高的PSAD与BCR独立相关，并且作为RALP术后BCR的预测指标优于PSA。
