Burkhardt Orlando, Neuenschwander Julia Esther, John Hubert, Randazzo Marco
Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur (Zürich), SWITZERLAND;
Kantonsspital Winterthur.
Swiss Med Wkly. 2018 Nov 26;148:w14685. doi: 10.4414/smw.2018.14685. eCollection 2018 Nov 19.
PURPOSE Sparing of the seminal vesicles during robotic radical prostatectomy (SVRP) is an attempt to reduce potential damage to the hypogastric pelvic nerves. However, the seminal vesicles are known to express prostate-specific antigen (PSA) and it is unknown whether SVRP influences oncological outcome measured with ultrasensitive PSA immunoassays. In a retrospective study we analysed whether SVRP affects oncological outcome in terms of ultrasensitive PSA nadir and biochemical recurrence as compared with standard robotic assisted laparoscopic radical prostatectomy (sRALP). METHODS Overall, 102 patients underwent robotic prostatectomy. Patients were non-randomly allocated to the following surgical techniques: a SVRP group of 39 patients who underwent robotic radical prostatectomy sparing the tips of the seminal vesicles; a standard group of 63 patients who were treated with sRALP. Inclusion criteria were histologically proven negative margins (R0) and negative lymph node status (pN0). PSA was measured with an ultrasensitive assay. The Mann-Whitney U-test was used to compare the differences in PSA nadir and follow-up PSA. Biochemical recurrence was diagnosed if PSA rose to ≥0.2 mg/ml. RESULTS Median (range) follow-up was 31.4 (16.4–43.8) months. Preoperative PSA was 5.8 (0.13–15.29) ng/ml in the SVRP group and 7.1 (0.8–46) ng/ml in the sRALP group. Two cases of biochemical recurrence occurred in the sRALP group during follow-up. One of these two patients presented with locally advanced prostate carcinoma diagnosed from the definitive pathological specimen (pT3b). No patient of the SVRP group had seminal vesicle invasion or biochemical recurrence. No significant between-group difference in terms of PSA nadir and follow-up PSA was recorded. However, the percentage of patients who did not reach PSA nadir values of <0.01 ng/ml was higher in the SVRP group (10 vs 5% in the sRALP group). CONCLUSIONS Compared with sRALP, SVRP had no clinical impact on oncological outcome in terms of PSA nadir or biochemical recurrence measured with an ultrasensitive PSA immunoassay. A slightly higher PSA nadir after SVRP seems to be expected, which needs to be mentioned during follow-up of these patients.
目的 在机器人根治性前列腺切除术（SVRP）中保留精囊是为了减少对下腹盆腔神经的潜在损伤。然而，已知精囊会表达前列腺特异性抗原（PSA），尚不清楚SVRP是否会影响通过超敏PSA免疫测定法测得的肿瘤学结局。在一项回顾性研究中，我们分析了与标准机器人辅助腹腔镜根治性前列腺切除术（sRALP）相比，SVRP在超敏PSA最低点和生化复发方面是否会影响肿瘤学结局。方法 总体而言，102例患者接受了机器人前列腺切除术。患者被非随机分配到以下手术技术组：39例患者的SVRP组，接受保留精囊尖端的机器人根治性前列腺切除术；63例患者的标准组，接受sRALP治疗。纳入标准为组织学证实切缘阴性（R0）和淋巴结阴性。采用超敏测定法测量PSA。使用曼-惠特尼U检验比较PSA最低点和随访PSA的差异。如果PSA升至≥0.2 mg/ml，则诊断为生化复发。结果 中位（范围）随访时间为31.4（16.4 - 43.8）个月。SVRP组术前PSA为5.8（0.13 - 15.29）ng/ml，sRALP组为7.1（0.8 - 46）ng/ml。随访期间，sRALP组发生2例生化复发。这两名患者中的一名经最终病理标本诊断为局部晚期前列腺癌（pT3b）。SVRP组没有患者发生精囊侵犯或生化复发。在PSA最低点和随访PSA方面，未记录到显著的组间差异。然而，SVRP组未达到PSA最低点值<0.01 ng/ml的患者百分比更高（sRALP组为5%，SVRP组为10%）。结论 与sRALP相比，SVRP在通过超敏PSA免疫测定法测得的PSA最低点或生化复发方面对肿瘤学结局没有临床影响。SVRP后PSA最低点略高似乎是预期的，在这些患者的随访过程中需要提及这一点。
