Yang Che Hseuh, Lin Yi Sheng, Ou Yen Chuan, Weng Wei Chun, Huang Li Hua, Lu Chin Heng, Hsu Chao Yu, Tung Min Che
Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung 435403, Taiwan.
World J Clin Cases. 2021 Feb 16;9(5):1026-1036. doi: 10.12998/wjcc.v9.i5.1026.
pT2+ prostate cancer (PCa), a term first used in 2004, refers to organ-confined PCa characterized by a positive surgical margin (PSM) without extracapsular extension. Patients with a PSM are vulnerable to biochemical recurrence (BCR) following radical prostatectomy (RP); however, whether adjuvant radiotherapy (aRT) is imperative to PSM after RP remains controversial. This study had the longest follow-up on pT2+ PCa after robotic-assisted RP since 2004. Moreover, we discussed our viewpoints on pT2+ PCa based on real-world experiences.
To conclude a 10-year surveillance on pT2+ PCa and compare our results with those of the published literature.
Forty-eight patients who underwent robotic-assisted RP between 2008 and 2011 were enrolled. Two serial tests of prostate specific antigen (PSA) ≥ 0.2 ng/mL were defined as BCR. Various designed factors were analyzed using statistical tools for BCR risk. SAS 9.4 was applied and significance was defined as < 0.05. Univariate, multivariate, linear regression, and receiver operating characteristic (ROC) curve analyses were performed for statistical analyses.
With a median follow-up period of 9 years, 25 (52%) patients had BCR (BCR group), and the remaining 23 (48%) patients did not (non-BCR group). The median time for BCR test was 4 years from the first postoperative PSA nadir. Preoperative PSA was significantly different between the BCR and non-BCR groups ( < 0.001), and ROC curve analysis of preoperative PSA suggested a cut-off value of 19.09 ng/mL (sensitivity, 0.600; specificity: 0.739). The linear regression analysis showed no correlation between time to BCR and preoperative PSA (Pearson's correlation, 0.13; adjusted = 0.026).
Robotic-assisted RP in pT2+ PCa of worse conditions can provide better BCR-free survival. A surgical technique limiting the PSM in favorable situations is warranted to lower the pT2+ PCa BCR rate. Preoperative PSA cut-off value of 19.09 ng/mL is a predictive factor for BCR. Based on our experiences and review of the literature, we do not recommend routine aRT for pT2+ PCa.
pT2+前列腺癌（PCa）这一术语于2004年首次使用，指的是局限于器官的PCa，其特征为手术切缘阳性（PSM）且无包膜外侵犯。PSM患者在根治性前列腺切除术（RP）后易发生生化复发（BCR）；然而，RP术后PSM患者是否必须接受辅助放疗（aRT）仍存在争议。本研究是自2004年以来对机器人辅助RP术后pT2+ PCa进行随访时间最长的研究。此外，我们基于实际经验讨论了我们对pT2+ PCa的观点。
总结对pT2+ PCa的10年监测情况，并将我们的结果与已发表文献的结果进行比较。
纳入2008年至2011年间接受机器人辅助RP的48例患者。连续两次前列腺特异性抗原（PSA）检测≥0.2 ng/mL被定义为BCR。使用统计工具分析各种设计因素的BCR风险。应用SAS 9.4，显著性定义为<0.05。进行单因素、多因素、线性回归和受试者工作特征（ROC）曲线分析以进行统计分析。
中位随访期为9年，25例（52%）患者发生BCR（BCR组），其余23例（48%）患者未发生（非BCR组）。BCR检测的中位时间为首次术后PSA最低点后4年。BCR组和非BCR组术前PSA有显著差异（<0.001），术前PSA的ROC曲线分析显示临界值为19.09 ng/mL（敏感性，0.600；特异性：0.739）。线性回归分析显示BCR时间与术前PSA之间无相关性（Pearson相关性，0.13；校正 = 0.026）。
对病情较差的pT2+ PCa进行机器人辅助RP可提供更好的无BCR生存。在有利情况下采用限制PSM的手术技术对于降低pT2+ PCa的BCR率是必要的。术前PSA临界值19.09 ng/mL是BCR的预测因素。基于我们的经验和文献回顾，我们不建议对pT2+ PCa常规进行aRT。
