機器手臂攝護腺根除手術治療病理T3期攝護腺癌
吳勝堂、高建璋、曹智惟、唐守宏、蒙恩、孫光煥、于大雄、范保羅、張聖原、查岱龍
國防醫學院 三軍總醫院 外科部 泌尿外科
Patients with pathological t3 prostate cancer treated with robot-assisted radical prostatectomy - a single institue experience
Seng-Tang Wu, Chien-Chang Kao, Chu-Wei Tsao, Shou-Hung Tang, En Meng, Guang-Huan Sun, Dah-Shyong Yu, Pao-Luo Fan, Sun-Yran Chang, Tai-Lung Cha
Division of Urology, Department of Surgery, Tri-Service General Hospital, National
Defense Medical Center, Taipei, Taiwan
Purpose: We analyzed the surgical results of prostate cancer in patients who had pT3 disease were treated by robot-assisted radical prostatectomy (RARP) at our hospital.
Materials and Methods: There were over 500 prostate cancers had been treated by RARP at our institution. We review 363 consecutive patients who underwent RARP by a single surgeon from September 2009 to February 2015. Peri- and post-operative data were collected and analyzed for all patients.
Results: In total, 363 consecutive patients underwent RARP. Seven patients with distant metastases at diagnosis, had neoadjuvant therapy and pathological T0 disease were excluded. Of these 356 patients, the mean age was 65.2 years, the mean pre-operative PSA was 10.2 ng/mL. 123 (34.6%) patients with mean age 65.9 and mean pre-operative PSA 13.9 ng/mL were found to have pT3 disease, including pT3a in 80 and pT3b in 43 cases. The PSM rate for patients with pT3 disease was 56.2%. The PSM rate for patients with pT3a and pT3b disease was 51.3% and 39.5%, respectively. Comparing pT3 with pT2 cases, the patient’s age, prostate weight were no different. The pT3 group had higher mean pre-operative PSA level (13.4 vs 22.3 ng/mL), percentage of tumor volume (14.4% vs 22.3%), positive margin rates (9.9% vs 54.5%), biopsy and prostatectomy specimen Gleason score (6.7 vs 7.3, and 7.0 vs 7.4). 37 (30.1%) in 109 pT3 patients with biochemical recurrence (BCR), time to BCR was 24 months. Biopsy Gleason score is the only independent preoperative predictor of BCR in pT3a cases. Biopsy Gleason and preoperative PSA are the only independent preoperative predictors of BCR in pT3b RARP cases.
Conclusions: We present the results of the treatment for locally advanced prostate cancer initially managed with RARP. Our findings suggest that patients with locally advanced prostate cancer can be treated with RARP with higher but acceptable positive margin rates and surgical results.