Treatment of clinically localized prostate cancer
https://doi.org/10.17650/1726-9776-2008-4-4-38-44
Abstract
Purpose of our study is to carry out: comparative analysis of results of radical prostatectomy and conformal radiotherapy in patients with clinically localized prostate cancer.
Materials and methods. For retrospective analysis we chose data from 177 patients with stage сT1—2N0M0 prostate cancer treated in the N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences from 1997 to 2007. Median age of patients was 61,3 years and ranged from 38 to 76 years. Before treatment median level of serum prostate specific antigen was 15,5±15,1 ng/ml and median Gleason index — 2,6±0,7 + 3,2±0,6 = 5,7±1,1. Retropubic radical prostatectomy was performed in 133 (75,4%) patients and external conformal radiotherapy — in 44 (24,6%) patients. Study groups were matched according to main parameters. Median follow-up time was 26,2±30,2 months.
Results. Prostate gland capsule invasion was found in у 43 (32,3%), perineural growth — in 56 (31,3%), invasion of seminal vesicles — in 12 (6,8%), angiolymphatic invasion — in 53 (29,9%), positive surgical margins — in 9 (5,1%), pN+ — in 7 (4,0%) from 133 operated patients. In all 44 cases compete responses to radiotherapy were registered. Among 177 patients 5-year survival was 95,0%, specific survival — 100%, and survival without PSA relapse — 76,8%. According to monofactorial and multifactorial analyses favorable prognostic factors for survival without PSA relapse are radical prostatectomy (р=0,003 and р=0,019 respectively) and Gleason index <7 (p=0,012 and p=0,045 respectively). Advantage of operated patients over the patients treated with radiotherapy in regard to survival without PSA relapse rates is statistically significant in cases with Gleason indices <7 (р=0,013) and initial level of serum prostate specific antigen <10 ng/ml (р=0,005).
Conclusion. Both surgical treatment and radiotherapy allows reaching favorable results in patients with stage cT1—2N0M0 prostate cancer. It is obvious that when choosing the preferred treatment modality the Gleason index and level of prostate specific antigen should be taken into account. Probably, repeat analysis after longer follow up time will allow drawing more definite conclusions about advantages of surgery and radiotherapy in the treatment of patients with stage cT1—2N0M0 prostate cancer of different prognostic groups.
About the Authors
V. B. Matveyev
State Enterprise N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences; Moscow State Medical and Dentistry University
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
S. I. Tkachev
State Enterprise N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences; Moscow State Medical and Dentistry University
Russian Federation
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
M. I. Volkova
State Enterprise N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences; Moscow State Medical and Dentistry University
Russian Federation
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
A. A. Mitin
State Enterprise N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences; Moscow State Medical and Dentistry University
Russian Federation
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
V. M. Shelepova
State Enterprise N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences; Moscow State Medical and Dentistry University
Russian Federation
Russian Federation
Department of Oncology of Faculty for Post-Graduate Education of MSMDU
References
1. Kirby R. Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting. Nat Clin Pract Urol 2005;2(6):298—303.
2. Lepor H., Nieder A.M., Ferrandino M.N. Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 2001;166(5):1729—33.
3. Heinzer H., Hammerer P., Graefen M. et al. Thromboembolic complication rate after radical retropubic prostatectomy. Impact of routine ultrasonography for the detection of pelvic lymphoceles and hematomas. Eur Urol 1998;33(1):86—90.
4. Pepper R.J., Pati J., Kaisary A.V. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int 2005;95(6):772—5.
5. Solberg A., Angelsen A., Bergan U. et al. Frequency of lymphoceles after open and laparoscopic pelvic lymph node dissection in patients with prostate cancer. Scand J Urol Nephrol 2003;37(3):218—21.
6. Partin A.W., Mangold L.A., Lamm D.M. et al. Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 2001;58:843—8.
7. Roberts W.W., Bergstralh E.J., Blute M.L. et al. Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy. Urology 2001;57:1033—7.
8. King C.R. Patterns of prostate cancer biopsy grading trends and clinical implications. Int J Cancer 2000;90:305—11.
9. Miyake H., Kurahashi T., Takenaka A. et al. Improved accuracy for predicting the gleason score of prostate cancer by increasing the number of transrectal biopsy cores. Urol Int 2007;79:302—6.
10. Hsu C.Y., Joniau S., Oyen R. et al. Detection of clinical unilateral T3a prostate cancer — by digital rectal examination or transrectal ultrasonography? BJU Int 2006;98(5):982—5.
11. Potosky A.L., Legler J., Albertsen P.C. et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the prostate Cancer outcomes study. J Nat Cancer Inst 2000;92(19):1582—92.
12. Madalinska J.B., Essink-Bot M.L., de Koning H.J. et al. Quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol 2001;19(6):1619—28.
13. Bianco F.J., Grignon D.J., Sakr W.A. et al. Radical prostatectomy with bladder neck preservation: impact of a positive margin. Eur Urol 2003;43(5):461—6.
14. Selli C., De Antoni P., Moro U. et al. Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy. Scand J Urol Nephrol 2004;38(1):32—7.
15. Nandipati K.C., Raina R., Agarwal A. et al. Nerve-sparing surgery significantly affects long-term continence after radical prostatectomy. Urology 2007;70(6):1127—30.
16. Wagner A.A., Link R.E., Trock B.J. et al. Comparison of open and laparoscopic radical prostatectomy outcomes from a surgeon's early experience. Urology 2007;70(4):667—71.
17. Kundu S.D., Roehl K.A., Eggener S.E. et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004;172(6):2227—31.
18. Alibhai S.M., Leach M., Warde P.R. Major early complications after radical radiotherapy (RT) among 8,615 men: impact of age, comorbidity, and time. Proc ASCO 2005;abstr 98.
19. Claudio J. et al. Survival after radical prostatectomy and radiotherapy: a population-based study of 17,570 men. AUA 2007;abstr 380.
20. Kattan M.W., Wheeler T.M., Scardino P.T. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol 1999;17(5):1499.
Review
For citations:
Matveyev V.B., Tkachev S.I., Volkova M.I., Mitin A.A., Shelepova V.M. Treatment of clinically localized prostate cancer. Cancer Urology. 2008;4(4):38-44. (In Russ.) https://doi.org/10.17650/1726-9776-2008-4-4-38-44
Views:
277
Email this article 