Hamidi Nurullah, Atmaca Ali Fuat, Canda Abdullah Erdem, Keske Murat, Ardıçoğlu Arslan
Department of Urology, Atatürk Training and Research Hospital, Ankara, Turkey.
Department of Urology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
Turk J Urol. 2019 Dec;45(Supp. 1):S42-S48. doi: 10.5152/tud.2018.41017. Epub 2018 Aug 31.
To evaluate the effect of prostate-specific antigen (PSA) fluctuation on Gleason score (GS) upgrading, disease upstaging, oncological outcomes in low-risk prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) and met the inclusion criteria for active surveillance (AS).
Data of 354 low-risk PCa patients who underwent RARP were retrospectively evaluated. Patients were divided into two groups: PSA fluctuation rate<9.5%/month (Group 1, n=192) and >9.5%/month (Group 2, n=162). Mainly compared parameters were GS upgrading, disease upstaging, biochemical recurrence (BCR) and surgical margin positivity (SMP) rates.
GS upgrading, disease upstaging and SMP were detected in 128 (36.2%), 56 (15.8%) and 42 (11.9%) patients, respectively. After a median follow-up of 46 months, BCR was observed in 40 (11.3%) patients. GS upgrading (41.1% vs. 30.2%, p=0.033), disease upstaging (19.8% vs. 11.1%, p=0.028), SMP (15.1% vs. 8%, p=0.035) and BCR development (15.6% vs. 6.2%, p=0.005) rates were statistically significantly higher in Group 1 than Group 2. In multivariate analysis, digital rectal examination positivity, the presence of two positive cores and low PSA fluctuation rate were found to be significant predictors of GS upgrading.
Low PSA fluctuation rate is associated with higher GS upgrading.
评估前列腺特异性抗原（PSA）波动对接受机器人辅助腹腔镜根治性前列腺切除术（RARP）且符合主动监测（AS）纳入标准的低风险前列腺癌（PCa）患者的Gleason评分（GS）升级、疾病分期升级及肿瘤学结局的影响。
回顾性评估354例行RARP的低风险PCa患者的数据。患者分为两组：PSA波动率<9.5%/月（第1组，n = 192）和>9.5%/月（第2组，n = 162）。主要比较的参数为GS升级、疾病分期升级、生化复发（BCR）和手术切缘阳性（SMP）率。
分别在128例（36.2%）、56例（15.8%）和42例（11.9%）患者中检测到GS升级、疾病分期升级和SMP。中位随访46个月后，40例（11.3%）患者出现BCR。第1组的GS升级（41.1%对30.2%，p = 0.033）、疾病分期升级（19.8%对11.1%，p = 0.028）、SMP（15.1%对8%，p = 0.035）和BCR发生率（15.6%对6.2%，p = 0.005）均显著高于第2组。多因素分析显示，直肠指检阳性、两个阳性核心的存在以及低PSA波动率是GS升级的显著预测因素。
低PSA波动率与更高的GS升级相关。
