Mesut ÇETİNKAYA, Ali MEMİŞ, H. Cihan DEMİREL, Ç. Volkan ÖZTEKİN, A. Özgür AKDEMİR, C. Serkan GÖKKAYA

Radikal prostatektomi sonrası gleason skorundaki değişiklikleri öngörmede prostat biyopsisindeki kanser pozitif kor yüzdesi önemli midir?

Amaç: Pozitif biyopsi kor yüzdesi (PKY) ve radikal prostatektomi (RP) sonrası Gleason skoru değişiklikleri arasındaki ilişkiyi değerlendirmek. Yöntem ve Gereçler: Klinik lokalize prostat kanseri öntanısı ile RP yapılan 195 hasta çalışmaya dahil edildi. Hastaların klinik ve patolojik verileri retrospektif olarak incelendi. Biyopsideki ve RP materyalindeki Gleason skorları ve ilişkili klinik veriler kaydedildi. Hastalar, RP sonrası Gleason skorundaki değişikliğe (düşük evre, aynı, yüksek evre) ve pozitif biyopsi kor yüzdesine (≤0.20, 0.21-0.40, 0.41-0.60 and ≥0.61) göre gruplandırıldı. Bulgular: Radikal Prostatektomi sonrası Gleason skoru değerleri, öncekine göre hastaların % 47,6 sında artmış, % 40,2 sinde aynı, % 12,2 sinde ise azalmış olarak saptandı. Gruplar arasında yaş, bazal serum PSA düzeyi, prostat ağırlığı, klinik evre, biyopsi kor sayısı ve pozitif biyopsi kor yüzdesi açısından istatistiksel olarak anlamlı fark yoktu (hepsi için p>0,05). Pozitif biyopsi kor yüzdesi ≥0.61 olanlardaki Gleason skoru artışı (% 64,3), PKY ≤ 0.20 olanlardaki artışa göre anlamlı olarak daha fazla saptandı ( % 34) (p=0.03). Sonuç: Çalışmamızın sonucu göstermektedir ki neredeyse hastaların yarısında RP sonrasında Gleason skorunda artış saptanmaktadır ve bu değişiklik de anlamlı olarak PKY ile ilişkilidir.

Is percentage of cancer positive cores in prostate biopsy useful for predicting the changes in gleason scores after radical prostatectomy?

Aim: To evaluate the relation between the percentage of positive biopsy cores (PPC) and changes in Gleason scores after radical prostatectomy (RP). Material and Methods: Hundred and ninety-five patients who underwent RP for clinically localized prostate cancer were included in the study. The clinical and pathological data of the patients were retrospectively analyzed. Biopsy and RP Gleason scores, and related clinical data were recorded. Patients were grouped with respect to the changes in Gleason scores after RP (Downgraded, concordance and upgraded) and percentage of positive biopsy cores (≤0.20, 0.21-0.40, 0.41-0.60 and ≥0.61). Results: Of the patients, Gleason scores increased in 47.6%, remained unchanged in 40.2% and decreased in 12.2% after RP. There was no statistically significant difference among the groups regarding age, baseline serum PSA level, prostate volume, clinical stage, number of biopsy cores, and number of positive biopsy cores (p>0.05 for all). The rate of Gleason score increase in patients with a PPC ≥0.61 was significantly higher than the ones with that of ≤ 0.20 (64.3% and 34%, respectively, p=0.03). Conclusions: The findings of our study showed that almost half of the patients experience an increase in Gleason score after RP and that this change is significantly associated with PPC.

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