Walsh P C, Partin A W, Epstein J I
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Urol. 1994 Nov;152(5 Pt 2):1831-6. doi: 10.1016/s0022-5347(17)32396-0.
The experience after 10 years with anatomical radical retropubic prostatectomy at The Johns Hopkins Hospital is reviewed. Between April 1982 and March 1991, 955 men with clinically localized prostate cancer (clinical stages T1 to T2) underwent staging pelvic lymphadenectomy and anatomical radical retropubic prostatectomy. Using actuarial analysis, at 10 years the likelihood of an undetectable prostate specific antigen (PSA) level was 70%, isolated elevation of PSA 23%, distant metastases 7% and local recurrence 4%. The actuarial likelihood of an elevated serum PSA increased with increasing pathological stage: the 10-year likelihood of freedom from PSA relapse was 85% for men with organ confined disease, 82% with focal capsular penetration, 54% with established capsular penetration and Gleason score 2 to 6 disease, 42% with established capsular penetration and Gleason score 7 to 10 disease, and 43% with seminal vesicle involvement. These data indicate that radical prostatectomy cures the majority of men with organ confined disease or with well to moderately well differentiated tumors that have penetrated the prostatic capsule to the extent where it is possible to obtain a clear surgical margin. Radical prostatectomy should be reserved for patients who can be cured and who will live long enough to benefit from it. These are also the patients who have the best quality of life postoperatively.
回顾了约翰霍普金斯医院开展耻骨后根治性前列腺切除术10年的经验。1982年4月至1991年3月期间，955例临床局限性前列腺癌（临床分期T1至T2）患者接受了分期盆腔淋巴结清扫术和耻骨后根治性前列腺切除术。采用精算分析，10年后前列腺特异性抗原（PSA）水平检测不到的可能性为70%，PSA单独升高为23%，远处转移为7%，局部复发为4%。血清PSA升高的精算可能性随病理分期增加而增加：器官局限性疾病患者10年无PSA复发的可能性为85%，局灶性包膜侵犯患者为82%，已确定包膜侵犯且Gleason评分为2至6分的疾病患者为54%，已确定包膜侵犯且Gleason评分为7至10分的疾病患者为42%，精囊受累患者为43%。这些数据表明，根治性前列腺切除术可治愈大多数器官局限性疾病患者或肿瘤分化良好至中等且已穿透前列腺包膜至能够获得清晰手术切缘程度的患者。根治性前列腺切除术应保留给能够治愈且寿命足够长以从中受益的患者。这些也是术后生活质量最佳的患者。
