Singh Shanky, Patil Saurabh, Tamhankar Ashwin Sunil, Ahluwalia Puneet, Gautam Gagan
Department of Urology, AIIMS, Rishikesh, Uttarakhand, India.
Department of Urooncology, Max Institute of Cancer Care, New Delhi, India.
Indian J Urol. 2020 Jul-Sep;36(3):184-190. doi: 10.4103/iju.IJU_37_20. Epub 2020 Jul 1.
Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question.
Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading.
The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4.
There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
在印度等亚洲国家，前列腺癌被认为具有高度侵袭性。这引发了一个争论，即在患有低风险前列腺癌（PCa）的印度男性中，与直接进行根治性前列腺切除术（RP）相比，主动监测（AS）是否会给人一种虚假的安全感。我们分析了前瞻性维护的机器人辅助RP（RARP）数据库以解决这个问题。
2013年9月至2019年9月，由单一手术团队对567名男性进行了RARP手术。其中，根据美国国立综合癌症网络标准，46名（8.1%）为低风险患者。比较手术前后的 Gleason分级组和分期，以确定升级和分期上升的发生率。分析术前临床和病理特征与分期上升和升级概率的相关性。
平均年龄为60.8±6.8岁。前列腺特异性抗原平均水平为6.7±2.0 ng/mL。40名（86.9%）患者为T1期疾病，6名（13%）患者临床分期为T2a期。共有25例（54.3%）病例出现分期上升或升级，19例（41.3%）无变化，其余2例（4.3%）在最终的RP标本上无恶性肿瘤。8例（17.4%）出现分期上升：5例（10.9%）升至pT3a，3例（6.5%）升至pT3b。23例（50%）出现升级：19例（41.3%）升至2级；3例（6.5%）升至3级；1例（2.2%）升至4级。
在适合进行主动监测的低风险PCa印度男性中，有50%的可能性出现分期上升或升级。应谨慎做出进行主动监测的决定。
