Trapasso J G, deKernion J B, Smith R B, Dorey F
Department of Surgery, UCLA Medical Center.
J Urol. 1994 Nov;152(5 Pt 2):1821-5. doi: 10.1016/s0022-5347(17)32394-7.
A total of 601 patients who underwent radical retropubic prostatectomy for localized prostate cancer at our institution was followed with serial prostatic specific antigen (PSA) determinations. Three separate groups were delineated by pathological stage: 293 patients with organ confined disease, 215 with involvement of the capsule or positive margins and 93 with extension to the seminal vesicles. Followup ranged from 12 to 237 months (median 34). Five and 10-year disease-free survival rates for the 601 patients were 86 +/- 2% and 78 +/- 3%, respectively. The rate of detectable PSA (greater than 0.4 ng./ml.), used as an indicator of cancer progression, revealed 5 and 10-year disease-free rates of 69 +/- 2% and 47 +/- 3%, respectively. When comparing the patients from an earlier series to those who underwent surgery after 1986, an improvement in the 5-year clinical disease-free rate was noted (78 +/- 2% versus 93 +/- 2%, respectively). Similarly, an improvement in the 5-year disease-free survival rate with nondetectable PSA level was demonstrated in our contemporary series (80 +/- 3%) compared to our historical series. Of the 601 patients 123 had a detectable post-prostatectomy PSA level with or without clinical evidence of metastasis. A PSA doubling time before onset of adjuvant therapy was determined in 94 patients. Post-prostatectomy PSA doubling times were significantly different when comparing the patients who ultimately had progression to distant metastases (median 4.3 months) to those with either clinical local recurrence or a PSA elevation as the sole indicator of recurrence (median 11.7 months). Radical retropubic prostatectomy, whether assessed by clinical or biochemical means, has demonstrated excellent disease-free survival rates, especially since the advent of PSA and anatomical radical prostatectomy.
共有601例在我院接受耻骨后根治性前列腺切除术治疗局限性前列腺癌的患者接受了系列前列腺特异性抗原（PSA）测定随访。根据病理分期划分出三个不同的组：293例器官局限性疾病患者，215例有包膜侵犯或切缘阳性患者，93例有精囊侵犯患者。随访时间为12至237个月（中位时间34个月）。601例患者的5年和10年无病生存率分别为86±2%和78±3%。用作癌症进展指标的可检测PSA（大于0.4 ng/ml）率显示，5年和10年无病率分别为69±2%和47±3%。将早期系列的患者与1986年后接受手术的患者进行比较时，注意到5年临床无病率有所改善（分别为78±2%和93±2%）。同样，与我们的历史系列相比，在我们当代系列中，PSA水平不可检测的患者5年无病生存率也有所提高（80±3%）。601例患者中，123例术后PSA水平可检测，无论有无转移的临床证据。对94例患者测定了辅助治疗开始前的PSA倍增时间。将最终发生远处转移的患者（中位时间4.3个月）与临床局部复发或PSA升高作为复发唯一指标的患者（中位时间11.7个月）进行比较时，术后PSA倍增时间有显著差异。耻骨后根治性前列腺切除术，无论是通过临床还是生化手段评估，都显示出优异的无病生存率，尤其是自PSA和解剖性根治性前列腺切除术出现以来。
