楊哲學、林益聖、歐宴泉、許兆畬、童敏哲

童綜合醫院 外科部 泌尿科

Che-Hsueh Yang, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Hsu, Min-Che Tung

Division of Urology, Department of Surgery, Tung’s MetroHarbour Hospital,Taichung

Taiwan

 

Purpose: Patients were diagnosed prostate cancer and after receiving radical prostatectomy (RP), they may have pathological T2+(pT2+), representing an organ confined tumor with extension to inked surgical margins, but with no evidence of extension into extra-prostatic tissue or invasion of the seminal vesicles. Some of them experienced biochemical recurrence (BCR) during follow-ups, but the others were not (non-BCR). We reviewed and analyzed the various variants on BCR of prostate cancer.

Materials and Methods: This is a retrospective cohort study from 2008 to 2011, and total 48 patients undergoing robotic-assisted RP with the pathological T stage pT2+ were enrolled. They were followed for 7 to 10 years, and were subdivided into two groups as BCR group (PSA≥0.2ng/ml) and non-BCR group (PSA<0.2ng/ml). Several variants were designed to test if any significant difference exists between these two groups. Student t test and Chi square test were applied to analyze the data. The software SAS 9.4 was used. P<0.05 was considered to be statistically significant.

Results: Total 25 patients (52%) had BCR, while the other 23 patients (48%) did not. The basic characteristics, such as age, BMI, resected tumor volume and percentage, biopsy chips and cancer cell percentage, and biopsy core, were compared with no significant differences between these two groups. Mean age in BCR group was 66.5(±4.7) years old and 69.0(±5.4) in non-BCR group(p=0.102).BMI was 24.32(±3.0) in BCR group and 25.6(±2.7) in non-BCR group(p=0.702).In resected tumor volume, there was 7.0(±5.7) mg out of 51.0(±36.3) mg specimen(15.1(±9.8)%) in BCR, and 4.9(±3.4) mg out of 41.7(±11.5) mg (12.8(±9.5)%) in non-BCR(p=0.406). In positive chips out of prostate biopsy, BCR groups was 4.3(±2.8) positive chips in total 10.1(±2.0) chips, and non-BCR groups was 4.1(±2.5) out of total 10.5(±1.9) chips (p =0.832). In cancer cells out of biopsy percentage, BCR group was 26.5% (±21.2%), compared to non-BCR group of 24.0% (±20.3%) (p=0.686). There was significant difference in pre-operative PSA value between BCR group and non-BCR group, which were 28.6 ng/ml (±19.9) and 17.0 ng/ml (±11.3) respectively (p<0.001). Except for it, we could not find any significant difference in others. In biopsy cores, there were 7 patients in BCR group with <3 fragments and 5 patients in non-BCR, 12 patients in BCR group with between 3 fragments to 50% and 13 patients in non-BCR group, and 3 patients in both groups having biopsy core >50 %(p=0.839). There was neither significant difference in biopsy Gleason score(p=0.626), nor in primary Gleason score(p=0.418).Risk category failed to showed significant difference as well(p=0.493).Change of risk categories after operation showed no significant differences(p=0.223). The clinical stage, been categorized into T1, T2a, T2b, T2c, and T3, revealed no significant differences between these two groups (p=0.445).22 patients (88%) of BCR group proved to be peri-neural invasion and 15 patients (65.2%) in non-BCR group (p=0.061). No enough data could draw a conclusion from the variant of anterior lobe invasion. Pre-operative image diagnosis as organ-confined were 20 patients (80%) and 19 patients (82.6%) respectively on BCR and non-BCR (p=0.817). Pre-operative diagnosis as extra-capsular extension case were both 3 patients in both BCR(12%) and non-BCR group(13%) (p=0.9130).

Conclusions: There is significant correlation of pre-operative PSA level with BCR. The higher the pre-operative PSA is, the more possibility of patients encounter with BCR with pathological results of pT2+.