Flanigan R C, McKay T C, Olson M, Shankey T V, Pyle J, Waters W B
Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA.
Urology. 1996 Sep;48(3):428-32. doi: 10.1016/S0090-4295(96)00161-6.
To evaluate the efficacy of preoperative computed tomographic (CT) scanning in patients with presumed localized prostatectomy prior to radical retropubic prostatectomy.
A retrospective study of 173 consecutive patients believed to be candidates for radical retropubic prostatectomy who underwent preoperative CT scanning regardless of preoperative prostate-specific antigen (PSA) value, clinical stage, or Gleason grade was undertaken. All patients underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection or aspiration needle biopsy of abnormal nodes on CT scanning.
One hundred sixty-five of 173 patients (95.4%) were believed to have normal CT scans preoperatively. Of these 165 patients, 156 (94.5%) were found to have negative lymph nodes confirmed histologically at the time of lymphadenectomy. Nine patients (5.5%) were found to have lymph node metastases confirmed histologically, despite a negative CT scan. Computed tomographic scanning understaged 9 of 12 (75%) patients with proven metastases. Incidental abdominal pathology of clinical significance was documented in 4 patients (2.3%), including 2 with renal cell cancers, 1 with colon cancer, and 1 with a large (8 cm) abdominal aortic aneurysm. Prostate-specific antigen levels in patients with metastatic lymph nodes ranged from 0.7 to 130 ng/mL (Hybritech Tandem assay), with a mean level of 42 ng/mL. Although 9 of 33 patients (27.3%) with PSA levels greater than 25 ng/mL had node metastases, only 3 of these 33 patients (9.1%) were correctly diagnosed by CT scanning.
Although additional numbers of patients with high PSA levels need to be evaluated, we could not find any justification for routine preoperative CT scanning in patients with a PSA of less than 25 ng/mL. These results suggest that significant savings can be realized by abandoning the practice of routine CT scanning for lymph node metastasis in all patients with newly diagnosed prostate cancer.
评估术前计算机断层扫描（CT）在耻骨后根治性前列腺切除术前行局限性前列腺切除术患者中的疗效。
对173例连续接受术前CT扫描的患者进行回顾性研究，这些患者被认为是耻骨后根治性前列腺切除术的候选者，无论术前前列腺特异性抗原（PSA）值、临床分期或Gleason分级如何。所有患者均接受耻骨后根治性前列腺切除术及双侧盆腔淋巴结清扫术，或对CT扫描显示异常的淋巴结进行穿刺活检。
173例患者中有165例（95.4%）术前CT扫描被认为正常。在这165例患者中，156例（94.5%）在淋巴结清扫时经组织学证实淋巴结阴性。9例（5.5%）患者尽管CT扫描阴性，但经组织学证实有淋巴结转移。12例经证实有转移的患者中，CT扫描对9例（75%）患者分期过低。4例（2.3%）患者记录有具有临床意义的偶然腹部病变，包括2例肾细胞癌、1例结肠癌和1例大的（8 cm）腹主动脉瘤。有转移淋巴结的患者前列腺特异性抗原水平范围为0.7至130 ng/mL（Hybritech Tandem检测法），平均水平为42 ng/mL。尽管33例PSA水平大于25 ng/mL的患者中有9例（27.3%）有淋巴结转移，但这33例患者中只有3例（9.1%）通过CT扫描被正确诊断。
尽管需要评估更多PSA水平高的患者，但我们未发现有任何理由对PSA小于25 ng/mL的患者进行常规术前CT扫描。这些结果表明，放弃对所有新诊断前列腺癌患者进行常规CT扫描以检测淋巴结转移的做法可实现显著的成本节约。
