Catalona W J, Smith D S
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
J Urol. 1994 Nov;152(5 Pt 2):1837-42. doi: 10.1016/s0022-5347(17)32397-2.
The new anatomical approach to radical retropubic prostatectomy with its nerve sparing option allows for preservation of erections, improved urinary continence, decreased blood loss, and lower operative mortality and morbidity rates. We sought to evaluate cancer control with this operation by determining the 5-year tumor recurrence rates using detectable serum prostate specific antigen levels as a criterion for tumor recurrence in a series of 925 consecutive men with clinical stage T1 or T2 prostate cancer. Overall, the 5-year probability of nonprogression was 78% (95% confidence limits 74 to 82%). The 5-year nonprogression rate was higher in patients whose tumors were not palpable (90% for impalpable tumors detected through transurethral resection of the prostate, 97% for impalpable prostate specific antigen detected tumors and 74% for palpable tumors). Nonprogression correlated with pathological tumor stage (91% for organ confined disease, 74% for positive margins or microscopic capsular perforation, 32% for seminal vesical invasion and virtually nil for lymph node metastases) and tumor grade (89% for well, 78% for moderately and 51% for poorly differentiated tumors). We conclude that anatomical radical prostatectomy achieves excellent cancer control for patients with organ confined prostate cancer.
新的耻骨后根治性前列腺切除术解剖入路及其保留神经的术式能够保留勃起功能、改善尿失禁情况、减少失血，并降低手术死亡率和发病率。我们试图通过以可检测的血清前列腺特异性抗原水平作为肿瘤复发的标准，来确定925例连续的临床分期为T1或T2期前列腺癌男性患者的5年肿瘤复发率，以此评估该手术的癌症控制效果。总体而言，5年无进展概率为78%（95%置信区间为74%至82%）。肿瘤不可触及的患者5年无进展率更高（经尿道前列腺切除术检测到的不可触及肿瘤为90%，前列腺特异性抗原检测到的不可触及肿瘤为97%，可触及肿瘤为74%）。无进展与病理肿瘤分期相关（器官局限性疾病为91%，切缘阳性或显微镜下包膜穿孔为74%，精囊侵犯为32%，淋巴结转移几乎为零）以及肿瘤分级相关（高分化肿瘤为89%，中分化肿瘤为78%，低分化肿瘤为51%）。我们得出结论，解剖性根治性前列腺切除术对器官局限性前列腺癌患者能实现出色的癌症控制。
