疑似攝護腺癌病患接受治療診斷性達文西機器手臂輔助腹腔鏡根除性攝護腺切除術預測攝護腺癌的機率模組
歐宴泉、黃立華、翁瑋駿、許兆畬、林益聖、童敏哲
童綜合醫院 外科部 泌尿科
Predictive parameters of prostate cancer for preoperatively suspicious prostate cancer receiving Theranostic robotic-Assisted laparoscopic radical prostatectomy: from experience with 153 cases
Yen Chuan Ou, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Shu, Yi-Sheng Lin, Min-Che Tung
Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Purpose: Expanded indications for preoperatively suspicious prostate cancer receiving Theranostic robotic-assisted laparoscopic radical prostatectomy (RARP) are previously reported. To analyze predictors of 153 cases of Theranostic RARP for preoperatively suspicious prostate cancer for final pathology proved prostate cancer.
Materials and Methods: This retrospective study reviewed data of a subset of 153 consecutive patients among 1450 patients who underwent RARP for preoperatively suspicious prostate cancer performed by the same surgeon from Dec. 2005 to Aug. 2017. Pathologic characteristics and outcomes of patients with suspected prostate cancer were analyzed and preoperative and intraoperative parameters were compared between three groups. Patients were stratified by final pathology reports of RARP specimens: Group I：Prostate cancer, N=69(45.1%); Group II: Abnormal (ASAP: atypical small acinar proliferation N=12; PIN: prostate intraepithelial neoplasia, N=35), N=47(30.7%); Group III: Benign (NH: nodular hyperplasia or inflammation), N=37(24.2%). Patients’ recorded preoperative demographic and clinical characteristics included age, body mass index (BMI), American Society of Anesthesiologists anesthetic/surgical risks class (ASA),PSA levels, Free /total PSA ratio, prostate volume, PSA density, history of acute urinary retention, abnormal DRE of prostate, PI-RADS (Prostate Imaging Reporting and Data System) classification at 3-T multiparametric (mp) MRI, Pateints having family history of prostate cancer and patients are medical personnel.
Results: Mean preoperative prostate specific antigen (PSA) was 18.2±3.31ng/mL. Intraoperative parameters included console time 110.18±4.01 min, blood loss 92.18±10.32 ml and mean prostate volume 67.01±4.33 cm3. No patients required blood transfusions. Predictive parameters of prostate cancer showed that PSA velocity (>0.75 vs. <0.75 ng/ml/yr), PI-RADS score 4/5, PSA density, Free/total PSA ratio and patient is medical personnel are good predictors for prostate cancer. Predictive scoring model for prostate cancer was developed as above parameters.
Conclusions: Prophylactic RARP with bilateral neurovascular bundle preservation is a safe and viable option for preoperatively suspicious prostate cancer performed by experienced surgeons. Preoperative predictive parameters of prostate cancer can adopt to explain patients and his family the possibility of prostate cancer for their decision-making. Our predictive scoring model need to validate by more cases and different cohort.