局部前列腺癌局部淋巴轉移前列腺根除術後長期追蹤結果
-楊啟瑞, 吳錫金, 張兆祥, 黃志平, 歐晏泉, 裘坤元, 蘇重光, 陳文銘, 李建儀, 王賢祥, 楊晨洸, 程千里
中國醫藥大學附設醫院泌尿部及台中榮民總醫院泌尿外科
The long-term survival outcome of radical prostatectomy for localized prostate cancer with positive lymph node
Chi-rei Yang1, Hsi-chin Wu1, Chao-hsiang Chang1, Yen-chuan Ou2, Chen-li Cheng2
Department of Urology, China Medical University Hospital, Taichung, Taiwan;
Division of Urology, Department of Surgery, Taichung Veterans General Hospital;2
Taichung, Taiwan
Purpose:
Although the indication of radical prostatectomy for lymph node-positive prostate cancer is controversy in past decades, the incidence of lymph node-positive prostate cancer is still common in high risk disease and the challenge remains on how well to treat these patients. Only long-term follow-up can give a true indication of the outcome in prostate cancer. Here we evaluated our experience in treating lymph node-positive prostate cancer following radical prostatectomy with more than ten years follow up.
Materials and Methods:
From Jan 1990 to Dec Nov 2006, 506 patients with localized prostate cancer underwent retropubic radical prostatectomy in TVGH. O them 42 patients with pathologic positive lymph nodes were under analysis for post operative outcome and long term follow up results. 90% of them had followed at least 10 years or until to death. Patient’s age ranged from 45 to 75 with a mean age of 65.2. According Nccn Criteria, one patient was classified as low risk, 7(17%) were as intermediate risk and 23(55%) as high risk and 11(24%) as very high risk. Following radical prostatectomy, Patients were follow PSA at 6th weeks and then very two months at initial 6 months and every 3 months further without adjuvant treatment. Salvage ADT with or without RT for PSA progressive rising > 0.3 ng/ml. The time to progression, overall survival and disease–specific survival rate calculated by using Kaplan Meier’s life-table.
Results:
Sixteen (38%) had one node positive, 16(38%) had two nodes positive and 10 (24%) had >3 positive nodes. Following radical prostatectomy, PSA were undetectable(<0.2ng/ml) in 18 (43%) patients. One and five years progression free survival rate were 30 and 14 %. The overall 5 and 10 years survival rate were 85 and 56%. The 5 and 10 years disease-specific survival rate were 90 and 60% respectively.
Conclusions:
Node positive may not indicate systemic disease. Extend nodes dissection plus radical prostatectomy may
produce durable period of disease free for some patients. Long term disease control may achieve following
salvage ADT with or without RT. The 5 and 10 overall and disease specific survival rate are higher compare
to other reported series of Western countries. Further studies compare to patient cohort with RT only is
warranted to prove how much benefit.