Garg Harshit, Seth Amlesh, Kumar Rajeev
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2022 Jan-Mar;38(1):22-28. doi: 10.4103/iju.iju_368_21. Epub 2022 Jan 1.
Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as "high-risk" prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as high risk due to adverse pathological features. We compared the operative, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP) in men with high-risk PCa categorized using PSA alone versus clinical and histopathological findings.
In an Institute Review Board-approved study, men undergoing RARP with high-risk PCa with at least 2-year follow-up were categorized into those with PSA >20 ng/ml being the sole criteria for being high risk (Group A) versus those with Gleason score ≥8 or ≥T2c disease but any PSA level (Group B). The two groups were compared for perioperative, oncological, and functional outcomes.
Fifty-three patients with high-risk disease were included. Twenty-six patients (48.9%) were classified into Group A while 27 patients (50.9%) were classified into Group B. The median PSA was significantly higher in Group A (31 [26-35] ng/ml in Group A vs. 21 [12-34] ng/ml in Group B, = 0.006) and on histopathology of radical prostatectomy specimen, 24 (92.3%) patients had GG ≤3 disease in Group A versus 10 (37%) patients in Group B ( < 0.001). Patients in both the groups had similar perioperative and continence outcomes. However, Group A had significantly lower biochemical recurrence rate (3/26 [11.5%]) as compared to Group B (11/27 [40.7%]) ( = 0.012).
PSA >20 ng/ml is the single most common criterion for stratification as high-risk PCa. However, men with PSA >20 ng/ml in isolation, without another adverse criterion, have better outcomes than men with adverse clinical or pathological criteria for high-risk disease.
孤立性前列腺特异性抗原（PSA）>20 ng/mL是将前列腺癌（PCa）分类为“高危”的标准之一。然而，在印度男性中，即使在没有PCa的情况下也经常出现PSA升高，并且仅以PSA作为高危疾病唯一标准的患者可能与因不良病理特征而被归类为高危的患者有不同的预后。我们比较了仅使用PSA与临床和组织病理学结果分类的高危PCa男性在机器人辅助根治性前列腺切除术（RARP）后的手术、肿瘤学和功能结果。
在一项经机构审查委员会批准的研究中，接受RARP且患有高危PCa并至少随访2年的男性被分为两组，一组以PSA>20 ng/ml作为高危的唯一标准（A组），另一组为Gleason评分≥8或≥T2c疾病但PSA水平任意（B组）。比较两组的围手术期、肿瘤学和功能结果。
纳入了53例高危疾病患者。26例患者（48.9%）被分类为A组，27例患者（50.9%）被分类为B组。A组的中位PSA显著更高（A组为31 [26 - 35] ng/ml，B组为21 [12 - 34] ng/ml，P = 0.006），在根治性前列腺切除标本的组织病理学检查中，A组24例（92.3%）患者的Gleason分级≤3级，而B组为10例（37%）患者（P < 0.001）。两组患者的围手术期和控尿结果相似。然而，A组的生化复发率（3/26 [11.5%]）显著低于B组（11/27 [40.7%]）（P = 0.012）。
PSA>20 ng/ml是高危PCa分层的最常见单一标准。然而，孤立性PSA>20 ng/ml且无其他不良标准的男性比具有高危疾病不良临床或病理标准的男性预后更好。
