Ürotelyal mesane kanseri tanısı ile radikal sistoprostatektomi yapılan hastalardaki rastlantısal prostat kanseri sıklığı ve klinik önemi

The frequency of the incidental prostate cancer of the patients that were diagnosed as bladder cancer and underwent radical cystectomy and the oncological outcomes

Turgay TURAN,Yavuz Onur DANACIĞLU,Furkan ŞENDOĞAN,Ramazan Gökhan ATIŞ,Turhan ÇAŞKURLU,Asıf YILDIRIM

Özet

Amaç: Mesane tümörü nedeniyle radi- kal sistoprostatektomi yapılan ve rastlantısal prostat adenokarsinomu saptanan hastaların insidansı, histopatolojik değerlendirme so- nuçları ve onkolojik sonuçlara etkisinin ince- lenmesi amaçlanmıştır. Materyal ve Metod: Kliniğimizde Ocak 2010 ve Aralık 2017 tarihleri arasında mesane tümörü tanısıyla radikal sistoprostatektomi yapılan ve preoperatif prostat kanseri şüphesi ve tanısı olmayan 190 hasta çalışmaya dahil edildi. Hastalar rastlantısal prostat kanseri saptanan ve saptanmayan grup olarak ikiye ayrıldı. Her iki grup yaş, operasyon öncesi PSA değeri, vücut kitle indeksi, mesane tü- mör evresi, derecesi, eşlik eden karsinoma in situ varlığı, cerrahi sınır pozitifliği, lenf nodu tutulumu ve genel sağkalım açısından karşılaştırıldı. Bulgular: Hastaların klinik ve histopatolojik verileri Tablo-1 ve Tablo-2’de özetlen- miştir. Histopatolojik incelemede hastaların 43`ünde (%22,6) prostat adenokarsinomu saptandı. Prostat kanseri saptanan hastalardaki operasyon öncesi ortalama PSA değeri 5,38 ng/ml ve prostat kanseri saptanmayan grupta ortalama PSA değeri 2,72 ng/ml idi (p=0,015). Ortalama takip süresi 26 ay (3-74) idi. Prostat kanseri nüksü 5 (%11,6) hastada saptandı. Beş yıllık genel sağkalım prostat kanseri saptanan hastalar için %61, prostat kanseri saptanmayan hastalar için %53 olarak sapandı (p=0,471). Sonuç: Radikal sistoprostatektomi sonrası rastlantısal prostat kanseri görülme sıklığı yaş ile birlikte artmakta ancak hastaların prognozunu kötü yönde etkilememektedir. Özellikle lokal ileri prostat kanserli hastalarının dikkatli ve düzenli takip edilmeleri gerekmektedir.

Abstract

Objective: The aim of this study was to evaluate the incidence, histopathological results and oncologic outcome of patients who underwent radical cystoprostatectomy for bladder tumors and detected incidental pros- tate adenocarcinoma. Materials-Methods: 190 patients who were not proved to have preoperative prostate cancer and underwent radical cystoprostatectomy and diagnosed as prostate cancer as a second cancer between January 2010 and December 2017 were included in this study. Patients were randomly divided into two groups those with and without incidentally prostate cancer. Both groups were compared in terms of age, preoperative PSA value, body mass index, stage and grade of bladder tumor, accompanying of carcinoma in situ, surgical margin positivity, lymph node involvement and overall survival retrospectively. Results: The clinical and the histopathological features of the patients were summarized on Table 1 and Table 2. Fourtthree of the 190 patients (22.6 %) were detected prostate adenocarcinoma by the histopathological evaluation. The mean preoperative PSA level was 5.38 ng / ml in patients who had prostate cancer and the mean PSA value in the group without prostate cancer was 2.72 ng/ ml (p=0,015). The mean duration of follow-up was 26 (3-74) months. The biochemical recurrence was detected at 5 (11.6%) patients during the follow-up. When the two groups were evaluated for 5-year survival rates that was 61% for patients with prostate cancer and 53% for patients without prostate cancer (p=0.471). Conclusion: The incidence of incidental prostate cancer after radical cystoprostatectomy increases with age but does not affect the prognosis of patients. In particular, the patients with locally advanced prostate cancer were needed to follow carefully and regularly.