Prostat biyopsi patolojisi ile radikal prostatektomi patolojilerinin karşılaştırılması
Amaç: Prostat spesifik antijenin tanımlanmasından sonra prostat kanserinin tanı oranı yükselmiştir. Prostat kanseri tanısı koymak için yapılan transrektal ultrasonografi eşliğinde prostat biyopsisi ile radikal prostatektomi spesimenindeki patolojilerin verileri arasında uyumsuzluk olabilmektedir. Bu durum küratif tedavi ihtiyacı olabilecek hastaları riske atarken, bazı hastalar için aşırı tedavi almasına neden olmaktadır. Bu çalışmada; radikal prostatektomi spesimenlerindeki Gleason skorları ile transrektal ultrasonografi eşliğinde biyopsi patolojilerindeki Gleason skorlarının karşılaştırılması amaçlanmıştır. Yöntemler: Ocak 2007 ile Kasım 2018 tarihleri arasında, kliniğimizde radikal prostatektomi cerrahisi geçirmiş hastaların verileri retrospektif olarak değerlendirildi. Hastaların transrektal ultrasonografi eşliğinde biyopsi öncesi PSA değerleri, biyopsi kor sayıları, kanser pozitif biyopsi kor sayıları, biyopsideki kanser yüzdeleri ve Gleason skorları tespit edilerek, radikal prostatektomi sonrası Gleason skorları, doku kanser oranları, cerrahi sınırlar ve patolojik evre ile karşılaştırıldı. Patolojik sınıflamada ISUP-WHO (Society of Urological Pathology:ISUP-World Health Organization) 2014 sınıflaması kullanılmıştır. Bulgular: Toplam 159 hastanın verileri değerlendirildi. Transrektal ultrasonografi eşliğinde prostat biyopsi patolojisinde, Gleason skoru 7 olarak tespit edildi. Biyopsi patolojisi ISUP 1 olan 109 hastanın 83 (%76,1) tanesinde radikal prostatektomi patolojisi ISUP 1 gelirken; biyopsi patoloji ISUP 2 olan 26 hastanın 8'inde(%30,7) radikal patolojisi ISUP 2 geldi. Biyopsi patolojisi ISUP 3 olan 16 hastanın ise 3'ünde(%31,2)radikal patolojisi ISUP 3 olarak rapor edildi. Biyopsi patolojisi ISUP 4 olan 6 hastanın ve ISUP 5 olan 2 hastanın ise radikal patolojisi farklı evrede rapor edildi. Sonuç: Transrektal ultrasonografi eşliğinde biyopsi patolojilerinde bildirilen Gleason skorları ile radikal prostatektomi Gleason skorları arasındaki fark; hastanın yaşı ve PSA değeri artıkça, prostat volümü azaldıkça bu fark daha belirgin olmaktadır.
Comparison of prostate biopsy pathology and radical prostatectomy pathologies
Objectives: The rate of prostate cancer has increased with the identification of the prostate-specific antigen; however,data on biopsy pathologies determined by transrectal ultrasonography may be incompatible with the pathologyindicated in radical prostatectomy specimens. This situation puts patients in need of curative treatment at risk whilein some patients they are overtreatment. The aim of this study was to compare Gleason scores in radicalprostatectomy specimens with the Gleason scores determined by transrectal ultrasound-guided biopsy pathologies.Methods: The data of patients who underwent radical prostatectomy in our clinic between January 2007 andNovember 2018 were evaluated retrospectively. Data included preoperative biopsy values, biopsy cores, biopsypercentage, Gleason scores from transrectal ultrasound-guided pre-biopsy biopsy cores, Gleason scores after radicalprostatectomy, tissue cancer rates, surgical margins, and pathological stage. The ISUP-WHO (Society of UrologicalPathology: ISUP-World Health Organization) 2014 classification was used for the pathological classification. Results: A total of 159 patients were evaluated. Transrectal ultrasonography-guided biopsy pathology revealed that82 (75.9%) patients with Gleason scores 7 based on transrectal ultrasonography-guidedpathology. The radical pathology of 109 patients with biopsy pathology was ISUP 1 in 83 (76.1%) patients. The radicalpathology was ISUP 3 in 5 of 16 patients with biopsy pathology ISUP 3 (31.2%). Six patients with biopsy pathologyISUP 4 and 2 patients with ISUP 5 was reported at different stages.Conclusions: Differences occur between the Gleason scores reported in transrectal ultrasonography-guided biopsyand radical prostatectomy pathologies. These differences become more evident as age increases, as PSA levelincreases and as prostate volume decreases.
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