低至中度風險攝護腺癌病人接受根治性攝護腺切除手術之結果分析:單一醫學中心之經驗

康庭碩、蔡佳穆、溫晨越、余家政、陳逸軒、郭威廷、林仁泰

高雄榮民總醫院 外科部 泌尿外科

Outcome of patients with low to intermediate risk prostate cancer receiving radical prostatectomy – A single center experience

Ting-Shuo Kang, Chia-Mu Tsai, Chen-Yueh Wen, Chia-Cheng Yu, I-Hsuan Alan Chen, Wei-Ting Kuo, Jen-Tai Lin

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Purpose:

Prostate cancer is common and oftentimes a slow growing cancer. For those patients with low-risk prostate cancer, treatment alternatives include watchful waiting (WW) by observation or palliative treatment only, active surveillance (AS) with curative treatment as needed in the setting of disease progression, radiotherapy and of course radical prostatectomy (RP). In this study, we reported our outcome of RP in patients with relatively low-risk prostate cancer.

Materials and methods:

We retrospectively reviewed the patients underwent radical prostatectomy from January 2011 to December 2020 in a single center, including 517 patients. 87 patients with 1. Grade group 1 from TRUS biopsy 2. Serum PSA<10 ng/ml 3. Clinical staging below T2c from MRI were enrolled. The pathological outcomes including Gleason score, staging and tumor location were assessed.

Results:

Among all patients, 8 patients underwent open radical prostatectomy, 3 patients underwent laparoscopic radical prostatectomy and 76 patients underwent robot-assisted radical prostatectomy. Upgrading of grade group was found in 47 (54.0%) patients and 7 (8.0%) patients were upstaged to pT3a or above. The upgrading to grade group 2 was reported in 40.2% of patient, 6.9% patients were upgraded to grade group 3, and 6.9% patients were upgraded to grade group 4 or above. 28 (32.2%) tumor were found in peripheral zone only, 28 (32.2%) were found in both peripheral zone and transitional zone and 31 (35.6%) were found in transitional zone only. No extraprostatic involvement was noted.

Conclusion:

Though some patients with low-risk disease who underwent radical prostatectomy were over treated, there is still a great portion of patients whose pathological outcome end up upgraded. To increase the safety of active surveillance in low-risk patient, diagnostic tool with higher precision may play an important role.