Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2006 / Cilt: 32 - Sayı: 1
Preoperative prediction of surgıcal margın status in patients with localized prostat cancer treated by radical prostatectomy
- Pages
- 30–36
- DOI
- —
Abstract
Introduction: Radical prostatectomy is commonly performed in patients with prostate carcinoma presumed to be confined to the prostate. Prediction of extraprostatic disease risk is important because of the negative impact of extraprostatic extension and positive surgical margins on progression and survival. The main objective of radical prostatectomy is the complete excision of the localized prostate cancer with negative surgical margins to control the disease. In this study, we assessed the value of clinical parameters for prediction of the extraprostatic extension and positive surgical margin in localized prostate cancer. Materials and Methods: From May 1996 to May 2003, 85 patients with localized prostate cancer underwent radical retropubic prostatectomy and pelvic lympadenectomy. Serum prostate specific antigen, digital rectal examination and transrectal ultrasound (TRUS) guided biopsy was done to all patients. Gleason score and the number and location of positive sextant biopsies were recorded for each patient. The prostate specimens were inked, fixed, serially sectioned and evaluated by two experienced pathologists. The incidence, location and number of positive surgical margins and extraprostatic extension of tumor were recorded. Results: Mean age value was 63.5 years (range between 48 and 72) and PSA value was 11.8 (ranging 1.9 to 35.3) ng/ml. Mean prostate volume measured by TRUS was 38.1 cc. Postoperatively, the pathologic stage was T2b in 15 (17.8%) patients, T2c in 23 (27%), T3a in 18 (21%), T3b in 15 (17.8%), T3c in 9 (10.6%), T4a in 5 (5.8%). Of the 85 men who had radical retropubic prostatectomy, 8 patients had pelvic lymph node involvement during frozen section examination. The tumor was bilateral in 60 (70.6%) patients. Of the study population, 20 of 85 (23.5%) patients had positive surgical margins including 6 (7%) at the right, 4 (4.7%) at the left and 10 (11.7%) at both prostatic lobes based on examination of the surgical specimen. Of the 85 patients, 47 (55.2%) had extraprostatic extension. The clinical parameters of age, PSA value, Gleason score after biopsy, bilateral cancer in biopsy and digital rectal examination were not statistically significant for preoperative prediction of surgical margin positivity (p>0.05) Conclusion: Digital rectal examination and transrectal-ultrasound guided sextant biopsy were not efficient to localize and to predict the extension of tumor. The clinical parameters of age, PSA value, Gleason score after biopsy, bilateral cancer in biopsy and digital rectal examination were not efficient to predict surgical margin positivity.
Özet
Çalışmamızda klinik olarak lokal evre prostat kanseri tanısıyla radikal retropubik prostatektomi (RRP) operasyonu uygulanan hastalarda ameliyat öncesi klinik parametrelerin, ekstraprostatik tümör yayılımı ve cerrahi sınırda tümör (CST) pozitifliğini öngörmede değerlerinin araştırılması amaçlandı. Mayıs 1996-Mayıs 2003 tarihleri arasında kliniğimizde prostat kanseri nedeniyle RRP ameliyatı uygulanan 85 hasta çalışma grubuna alındı. Kanserin prostat içerisindeki lokalizasyonu ve yaygınlığı zonlara ve loblara göre belirlenerek kaydedildi Hastaların klinik evrelendirmeleri yapıldıktan sonra ameliyatları yapıldı. Hastaların ortalama yaşı 63.5 (48-72), serum PSA düzeyleri ortalama 11.8 (1.9-35.3) ng/ml idi. Ameliyat sonrası patolojik incelemelerde 20 hastada CST pozitifliği saptandı. CST pozitifliği 10 hastada iki tarafta, 6 hastada sağ, 4 hastada ise sol tarafta belirlendi. Hasta yaşı, ameliyat öncesi serum PSA değeri, biyopsi Gleason skoru, PRM’de iki taraflı kanser şüphesi ve biyopside iki taraflı kanser bulunması parametrelerinin hiçbiri CST öngörüsünde istatistiksel bir anlamlılığa ulaşmadı (p>0.05). PRM ve sistematik 6 kadran prostat biyopsisi, prostat içinde tümör lokalizasyonunu ve yaygınlığını belirlemede yetersiz kalmaktadır. Ameliyat öncesi parametrelerden yaş, ameliyat öncesi PSA, biyopsi Gleason skoru, parmakla rektal incelemede iki taraflı kanser şüphesi olması ve biyopside iki taraflı kanser bulunması özelliklerinin CST öngörüsündeki değeri araştırıldığında bu parametrelerin kullanılması yeterli olmamaktadır.