Long term outcomes of retropubic radical prostatectomy and their prognostication
https://doi.org/10.17650/1726-9776-2008-4-3-57-63
Abstract
Radical retropubic prostatectomy is one of the most widely used and highly effective ways of managing of patients with clinically local prostate cancer.
Purpose: The purpose of our study is to evaluate long term results of treatment of patients with clinically local and locally advanced prostate cancer and to define prognostic factors.
Materials and methods: 332 patients with prostate cancer who underwent radical retropubic prostatectomy were followed up. Mean follow up time was 53,85±30,39 months. Local prostate cancer (pT2 disease) was found in 61,0% of patients, locally advanced (pT3) and advanced (pT4) stages of disease was registered in 39,0%. Finally, in 6,0% of patients involvement of regional lymph nodes was diagnosed.
Results: overall 5 and 7-year survival rates after radical retropubic prostatectomy were 89,85±2,02 and 89,1±2,14%, respectively; adjusted survival rates were identical (94,76±1,58%); disease free survivals were 62,38±3,18 and 44,03±3,67%, respectively. Relapses of prostate adenocarcinomas clearly correlate with preoperative serum level of prostate specific antigen and such pathologic signs as tumor differentiation grade and extent of disease (р≤0,05). Correlation of long term outcomes with results of digital rectal investigation of prostate gland, positive resection lines and lymph node involvement is less evident, but nonetheless statistically significant (р≤0,05).
Conclusions: radical retropubic prostatectomy is highly effective treatment modality for patients with local prostate cancer and for selected patients with locally advanced diseases. Determining the prognostic significance of various factors provides a mean to sort out patients at increased risk of disease relapse. This subset of patient needs close follow up to timely diagnose disease recurrence and adjust therapy, therefore improving survival of patients.
References
1. Велиев Е.И. Оптимизация хирургического лечения локализованных форм рака предстательной железы. Дис. … докт. мед. наук. СПб.; 2003.
2. Walsh P.C., Lepor H., Eggleston J.C. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983;4(5):473—85.
3. Tewari A., Menon M. Vattikuti Institute prostatectomy: surgical technique and current results. Curr Urol Rep 2003;4(2):119—23.
4. Han M., Partin A.W., Pound C.R. et al. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15year Johns Hopkins experience. Urol Clin North Am 2001;28(3):555—65.
5. Tewari A., Raman J.D., Chang P. et al. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology 2006;68(6):1268—74.
6. Freedland S.J., Isaacs W.B., Platz E.A. et al. Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol 2005;23(30):7546—54.
7. Zhou P., Chen M.-H., McLeod D. et al. Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol 2005;23(28):6992—8.
8. Cookson M.S., Aus G., Burnett A.L. et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for localized prostate cancer update panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 2007;177:540—5.
9. Юнкеров В.И., Григорьев С.Г. Математико-статистичекая обработка данных медицинских исследований. СПб., ВМА; 2005.
10. Kaplan E.L., Meier P. Nonparametric estimation from incomplete observations. J Am Statistical Association 1958;53:457—81.
Review
For citations:
Rakul S.A. Long term outcomes of retropubic radical prostatectomy and their prognostication. Cancer Urology. 2008;4(3):57-63. (In Russ.) https://doi.org/10.17650/1726-9776-2008-4-3-57-63
Views:
260
Email this article 