Cilj ovog istraživanja je bio procijentiti i ispitati Epsteinove ktiterije koji se koriste u procjeni lokaliziranog raka prostate i prema kojima se odlučuje o bolesnicima koji bi trebali biti aktivno praćeni umjesto da se podvrgnu radikalnom kirurškom zahvatu.
Ova je kohortno istraživanje. Podaci su prikupljeni na klinici za urologiju KBC-a Split. Ispitanici su podijeljeni u dvije skupine:
1. radikalno prostatektomirani koji su po Epstein kriterijima mogli biti aktivno praćeni , >65 godina,
2. radikalno prostatektomirani koji su po Epstein kriterijima mogli biti aktivno praćeni, <65. godina,
i to u razdoblju od 01. siječnja 2011. do 31. prosinca 2013. godine.
Klinika za urologiju, KBC Split, bolnica Križine, 2.kat
Svi muškarci koji su radikalno prostatektomirani na Klinici za urologiju u razdoblju od 2011. - 2013. godine.
GLAVNE MJERE ISHODA:
Od svih radikalno prostatektomiranih odabrani su oni koji su zadovoljavali Epstein kriterije aktivnog nadzora.
Analizirani su nepovoljni patološki ishodi kod tih bolesnika i to ekstrakapsularno širenje, zahvaćanje vesice seminalis, zahvaćanje kirurških rubova, nepovoljniji Gleason score i zahvaćanje limfnih čvorova u postoperativnom biopsijskom nalazu.
|Abstract (english)|| |
In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology in the group of low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy.
This is a contemporary cohort study. Data was collected at the department of urology, KBC- Split.The data was divided into two groups:
1. Patients who were threated with radical prostatectomy , but had all individual disease parameters inside the borders of Epstein biopsy criteria, >65.years ,
2. Patients who were threated with radical prostatectomy , but had all individual disease parameters inside the borders of Epstein biopsy criteria, <65.years ,
In the period from 2011 to 2013 at KBC Split.
Department of urology, KBC Split
All pacient who were threated with radical prostatectomy at he department of urology, KBC Split in the period from January 2011 to December 2013.
MAIN OUTCOME MEASURES:
Data were obtained from a prospectively maintained database of patients who were biopsied and operated in our institution. Both preoperative and postoperative serum PSA were obtained in our institution using the same kit. The biopsy and radical prostatectomy specimens were processed using standard fixation protocol and were evaluated by uropathologist.
PSA density was calculated using preoperative PSA divided by measured volume of the prostate in the radical prostatectomy specimen since preoperative transrectal ultrasound volume was not available for all patients.
We analyzed presence of the adverse pathological findings in the final pathohistological specimen after radical prostatectomy which exclude low risk disease: presence of extracapsular spread of the disease (ECE), positive surgical margins (SM), affectedness of the seminal vesicle (SVI), positive lymph nodes and Gleason score 7 – 10.
From 244 patients treated with radical prostatectomy in the analyzed period, 70 belonged to the low – risk group of patients for the above preoperative criteria and could be subjected to active surveillance.
Mean age was 63 (52 – 74) year, mean PSA was 6.2 (1.6 - 15.0) ng / mL, mean predoperative biopsy Gleason score was 5.57 (4 – 6), mean number of biopsy core was 8 (6 – 12).
Among them ECE, + SM, SVI were found in 20%, 18.6 % and 5.7% patients, respectively. Gleason score 7 was noted in 21 patients in the final pathohistological report, and Gleason score 8 – 10 in none.
Total, adverse pathohistological finding was noted in 25 patients, which was 35.6% of all patients that could be offered active surveillance.
Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low – risk patients.