針對高風險族群攝護腺癌使用根除性攝護腺併骨盆腔淋巴廓清手術治療:治療經驗

蔡禮賢、黃志平、陳汶吉、楊啟瑞、張兆祥、吳錫金

中國醫藥大學附設醫院泌尿部

      Oncological results of radical prostatectomy in high risk group prostate PATIENTS:  real world experience from Taiwan population

Li-Hsien Tsai, Chi-Pen Wang, Wen-Chi Chen, Chi-Rei Yang, Chao-Hsiang Chang, Hsi-Chin Wu

 Department of Urology, China Medical University Hospital

Purpose:

    Prostate cancer (PCa) is one of the most common male malignancy in the Western countries. Treatment option and survival outcome for PCa varied a lot depend on different risk stratification. Patients with high-risk Pca are at significant risk of biochemical failure, need for secondary therapy, distal metastasis, and disease-specific mortality rate. National Comprehensive Cancer Network (NCCN) suggests radiotherapy with hormone therapy (RT/HT) may be the first treatment option and radical prostatectomy (RP) should perform in particular patients. There were no prospective randomized controlled trials between two modalities. The optimal treatment for high-risk PCa is still a significant controversy. Most of the studies were based on Caucasian population. And Asia population data is lacking. We reported oncological results in high-risk group prostate patients who received radical prostatectomy from single medical center

Material and methods:

  Patients presented with high-risk PCa according to NCCN guideline at the single medical center was involved. We analyzed patient character, prostate-specific antigen (PSA), cancer staging, biochemical recurrence (BCR) free survival, disease-specific survival, the pattern of secondary hormone therapy and chemotherapy usage.  All patient received radical prostatectomy with extended bilateral pelvic lymph node dissection. Patients who received open, laparoscopic or robotic methods were all included. Postoperative follow-up PSA exceeds 0.2 was recorded as the biochemical failure.

Results:

   A total 153 high-risk patients treated with RP were enrolled. Median follow-up was 50 months. Sixty patients received open surgery while 26 and 67 patients underwent laparoscopic and robotic surgery receptively. Median PSA was 24.3 ( 2.83 - 130). Clinical stage was T1(33.3%), T2(64.7%) and T3(2.0%). The 5-year BCR-free survival for patients who received RP was 56.2%. Overall survival and disease-specific survival were 92.8, 99.3%, respectively. Forty patients found lymph node invasion from the pathology report.  49.5% patients needed less than one pad one month after operation then 69.7%, 73.4 when 3-month and 6-month follow-up. Subgroup analysis was made based on single or multiple high-risk factors on each patient. In RP group, both overall survival and 5-year BCR-free survival were better in the single risk group.  (84.8% VS 47.5%, P=0.022; 52.5% VS 13.2%, P<0.05)

Conclusion:

    High-risk PCa patients have a significantly higher rate of biochemical failure, need for secondary therapy, distal metastasis, and disease-specific mortality rate and worse survival outcome compared with low-to-intermediate group patients. Hormone therapy applied as an adjuvant after definitive radiotherapy was associated both promising results of BCR free survival and disease-specific survival. Near half of our study group patients met biochemical recurrence and needed for secondary treatment but final overall survival and disease-specific survival were satisfactory. Among patients treated with RP, a marked heterogeneity existed in the oncological outcomes. The number and character of high-risk group factors should be emphasized to decide the optimal treatments for patients with high-risk PCa. RP may be a more actively considered option for selected high-risk PCa patients.