1林口長庚醫院 泌尿腫瘤科；2長庚大學 臨床醫學研究所；3基隆長庚醫院 泌尿科
The preoperative factors that affect postoperative down staging of locally advanced prostate cancer
Po-Hung Lin1,2, See-Tong Pang1, Ying-Hsu Chang1, Chun-Te Wu3, Cheng-Keng Chuang1, Chung-Yi Liu1
1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan; 3Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
Purpose: Currently preoperative tumor staging of prostate cancer is based on digital rectal examination and image study. The main treatment strategies of locally advanced prostate cancer are radiotherapy and radical prostatectomy. We aimed to investigate the preoperative factors that affected postoperative down staging of prostate cancer.
Materials and Methods: Between 2007 and 2014 patients who diagnosed as locally advanced prostate cancer, which defined as T3-4N0M0 stage, and received radical prostatectomy were enrolled into this study. Preoperative initial prostate specific antigen (iPSA), digital rectal examination (DRE) result, biopsy Gleason score, and unilateral or bilateral positive biopsy result were collected as variants. Postoperative tumor stage, Gleason score, prostate gland volume, positive margin and adjuvant therapy were recorded for analysis.
Results: Total 113 patients were enrolled into this study. Fifty-nine patients (52.21%) had postoperative down staging. Patients with lower iPSA level, lower Gleason score, negative DRE and unilateral positive biopsy are more likely to have down staging. All patients had favorable cancer control result.
Though image study is still the mainstay
of preoperative staging of prostate cancer, we could combine with iPSA, DRE and biopsy Gleason score to predict the possibility of down staging to offer patient more treatment options. Radical surgery would still provide favorable cancer control for patients with locally advanced prostate cancer.