Yüksek Riskli Prostat Kanserinde Radikal Prostatektomi

Amaç: Yüksek riskli prostat kanserinin tedavisinde cerrahi ve radyoterapi seçenekleri bulunmaktadır. Günümüzde cerrahi tecrübenin artması nedeniyle yüksek riskli gruba da cerrahi uygulayan merkezler bulunmaktadır. Kliniğimizde yüksek riskli prostat kanseri tanısı konulup açık radikal prostatektomi uygulanan olguların fonksiyonel ve onkolojik sonuçlarını değerlendirdik.Yöntemler: Şubat 2011 ve Şubat 2015 tarihleri arasında radikal prostatektomi uygulanan 203 olgu çalışmaya alındı. Olguların 20 tanesinin yüksek riskli olduğu anlaşıldı. Bu olguların demografik ve karakteristik özellikleri retrospektif olarak toplandı. Yüksek riskli olgular ile diğer riskteki prostat kanseri olgularının özellikleri istatistiksel olarak karşılaştırıldı. Yüksek riskli olgularda biyokimyasal nüks ile ilişkili parametreler incelendi. Bulgular: Yüksek riskli prostat kanseri tanısı alan olguların ortalama yaşı 63.1 (aralık 56-69 yaş), ortalama PSA seviyeleri 14.2 ng/mL (aralık 9-46 ng/mL), ortalama takip süreleri 27.85 ay şeklinde bulundu. Olguların 11'inde (%55) biyokimyasal nüks izlendi. Yüksek riskli olgularda istatistiksel olarak biyokimyasal nüks ile sadece seminal vezikül invazyonu arasında ilişki anlamlı çıkmıştır.Sonuç: Bu bulgular neticesinde yaş, komorbidite ve hasta tercihi göz önünde bulundurularak yüksek riskli hastalarda cerrahi seçenek öncelikli olarak düşünülmesi gerekmektedir. Gleason skorunun onkolojik sonuçları öngörmede en önemli faktör olduğu ve klinik T3 evrelerin %20 kadarının organa sınırlı hastalık patolojisine sahip olabileceği unutulmamalıdır. Onkolojik ve fonksiyonel sonuçları bakımından yüksek risk ve düşük risk arasında anlamlı bir fark bulunmadığı ancak hastalara cerrahi sonrası ek tedavilerin gerekebileceği akılda tutulmalıdır.

Radical Prostatectomy In High-Risk Prostate Cancer

Objective: There are some treatment choices such as surgery and radiotherapy in the treatment of high-risk prostate cancer. Today, some centers prefer surgical procedures in high-risk group due to increasing surgical experience. In our clinic, we evaluated the functional and oncological outcomes of patients who underwent open radical prostatectomy in high-risk prostate cancer.Methods: Data on 203 patients underwent radical prostatectomy between February 2011 and February 2015 were investigated. There were 20 cases in high-risk group. Characteristics and demographic datas of these patients were collected retrospectively. The characteristics of high-risk patients with other risk cases were compared statistically. Parameters associated with biochemical recurrence were examined in high-risk patients.Results: Mean age of patients was 63.1 years (range 5669 years), the average PSA level were 14.2 ng / ml (range 9-46 ng / mL) and median follow-up was 27.85 months in high-risk prostate cancer. Biochemical recurrence was detected in 11 cases (55%). A statistically significant correlation was seen biochemical recurrence between seminal vesicle invasions in high-risk patients.Conclusion: Surgical options should be first preference in high-risk patients considering age, co-morbidity and patients choice in the result of these findings. Gleason score is the most important factor in predicting oncological outcomes and organ-confined disease may be in 20% of clinical stage T3. There is no significant difference between high risk and low risk patients in oncologic and functional outcomes but should be kept in mind additional treatment may need after surgery.

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