術前核磁共振與臨床因子為預測高風險與超高風險攝護腺癌術後生化復發之因子

楊晨洸¹、楊啟瑞²、歐晏泉³、程千里¹、賀昊中¹、裘坤元¹、王賢祥¹、李建儀¹、陳卷書¹、洪啟峰¹、陳正哲¹、王樹吉¹、林嘉彥¹、洪晟鈞¹

¹台中榮總外科部泌尿外科

²中國醫藥大學附設醫院泌尿部

³童綜合醫院泌尿科

Preoperative MRI and Clinical Factors are Predictors for Biochemical Recurrence in High and Very High Risk Prostate Cancer

Cheng-Kuang Yang, MD¹、Chi-Rei Yang, MD²、Yen-Chuan Ou, MD³、Chen-Li Cheng, MD¹、Hao-Chung Ho, MD^1、Kun-Yuan Chiu, MD¹、Shian-Shiang Wang, MD¹、Jian-Ri Li, MD¹, Chuan-Shu Chen, MD¹、Chi-Feng Hung , MD¹、Cheng-Che Chen, MD¹  、Shu-Chi Wang, MD¹、Chia-yen Lin, MD¹、Sheng-Chun Hung, MD¹

¹Devision of Urology, Department of Surgery, Taichung Veterans General Hospital;

²Department of Urology, China Medical University Hospital;

³Department of Urology, Tungs’ Taichung Metro Harbor Hospital.

Purpose: To identify the risk factors for biochemical recurrence (BCR) after radical prostatectomy in patients with high-risk and very high-risk prostate cancer.

Materials and Methods: Retrospective chart review was performed and patients with prostate cancer who underwent radical prostatectomy in one center from January 2009 to June 2020 were included. The information was reviewed from medical record, including demographics, surgery type, PLND status, and PSA value, image stage group, and pathological stage group at diagnosis and after surgery. Follow-up time was longer than 6 years. The primary end point was BCR in one year after surgery.

Results: A total number of 307 patients were included, with 120 in very high-risk group and 187 in high-risk group according to the National Comprehensive Cancer Network (NCCN) guideline. Compared to high-risk group, patients in the very high-risk group experienced poorer BCR-free survival and had a higher rate of BCR for patients with undetectably postoperative PSA, as well as higher risk for postoperative detectable PSA. For patients with undetectably postoperative PSA, BCR was associated with PSA density, image stage group 2 and 3, and pathological stage group 4. Postoperative detectable PSA was associated with pathological stage group 3 and 4.

Conclusion: Among patients with undetectably postoperative PSA, high PSA density, image stage group 2 and 3, and pathological stage group 4 are associated with BCR after prostatectomy, while those with pathological stage group 3 and 4 tumors showed higher risk for postoperative detectable PSA. These findings provide urologists information to decide active therapeutic protocols for patient with prostate cancer.