HAKAN TÜRK, Mustafa KARABIÇAK, Sıtkı ÜN, Okan Nabi YALBUZDAĞ, Naciye Ümit BAYOL, Tufan SÜELÖZGEN, Cemal Selçuk İŞOĞLU, Ferruh ZORLU, HÜSEYİN TARHAN

Radikal sistoprostatektomi yapılan hastalarda prostat kanseri insidansı ve klinik önemi

Amaç: Rastlantısal olarak radikal sistoprostatektomi (RSP) örneklerinde saptanan prostat adenokarsinomlarının çoğu lokalize ve iyi diferansiye klinik önemsiz kanserlerdir. Bu çalışmada R SP yapılan hastalarda rastlantısal saptanan prostat adenokanseri oranını saptamayı ve hastaların sağkalımlarına etkisini ortaya koymayı amaçladık. Gereç ve Yöntem: Eylül 2007 ile Mart 2014 tarihleri arasında mesane kanseri nedeniyle RSP yapılan hastalar retrospektif olarak incelendi. Hastaların cerrahi endikasyonu derin kas invazyonu olan ür otel i yal karsinom veya transüretral rezeksiyon ile kontrol altına alınamayan yüksek dereceli değişici epitel hücreli karsinom olmasıydı. Tüm hastalara standart RSP ve iki taraflı genişletilmiş pelvik lenfadenektomi yapıldı. Sistoprostatektomi materyalinde tüm örnekler dikkate alınarak tümörün Gleason derecesi, prostatik intraepitelyal neoplazi (PIN) birlikteliği, ekstrakapsüler yayılım, seminal vezikül tutulumu ve lenf no du metastazı değerlendirildi. Bulgular: Mesane ürotel i yal kanseri nedeniyle RSP uygulanan 126 hastanın 26sında (%20.6) rastlantısal prostat adenokanseri saptandı. Saptanan prostat kanserlerinin 16sı pT2a (%61.5), 8i T2c (%30.7) ve ikisi de T3b (%7.6) ev resinde idi. Hastaların 18inin Gleason skoru 6 ve altında, 6sının 7 (4+3) ve iki hastanın da 9 (5+4) olarak tespit edildi. Sonuç: Mesane kanseri nedeniyle RSP yapılan hastalarda geride prostat dokusu bırakılmadan tüm prostat dokusu çıkarılmalıdır. Mesane ve prostat kanseri birlikteliğinin yüksek olduğu akılda tutulmalı, dikkatli ve detaylı patolojik incelemeye ihtiyaç vardır.

Inci dence and clinical importance of prostate cancer in patients who underwent radical cystoprostatectomy

Aim: Incidental prostate adenocarcinomas which are detected in radical cystoprostatectomy (RCP) specimens are generally localized, well differentiated and have no clinical importance. In this study, we aimed to determine the rate of incidental prostate adenocarcinoma in patients underwent RCP and assess its effect on survival of the patients. Materials and Methods: The patients who underwent RCP for urothelial bladder cancer between September 2007 and March 2014 were analyzed retrospectively. Deep muscle invasion of urothelial carcinoma or high grade transitional epithelial cell carcinoma that could not be controlled by transurethral resection were the indications for surgery. Standard RCP and bilaterally expanded pelvic lymphadenectomy were performed in all patients. All samples of the cystoprostatectomy specimen were examined; Gleason degree of tumor, concurrent prostatic intraepithelial neoplasia, extracapsular extension, invasion of seminal vesicle, and metastasis of lymph nodes were evaluated. Results: Incidental prostate adenocarcinoma was diagnosed in 26 of 126 patients (20.6%) who underwent RCP for bladder urothelial carcinoma. The stages of prostate cancer were pT2a in 16 patients (61.5%), pT2c in 8 patients (30.7%), and T3b in 2 patients (7.6%). Gleason score was detected as lower than 6 in 18 patients, 7 (4+3) in 6 patients, and 9 (5+4) in 2 patients.Conclusion: All prostate tissue should be resected with no residual prostate tissue left in patients who underwent RCP for bladder cancer. The high coincidence of bladder and prostate cancers should be kept in mind, careful and detailed pathological examinations are needed.

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