Cüneyt ÖZDEN, Mesut ÇETİNKAYA, Ali MEMİŞ, Özgür UĞURLU, Mehmet YARIŞ, Ç. Volkan ÖZTEKİN, A. Özgür AKDEMİR

Anormal parmakla rektal muayene klinik lokalize prostat kanserli hastalarda yüksek radikal prostatektomi Gleason skorunu (≥7) öngörmede bağımsız bir parametredir

Amaç: Klinik lokalize prostat kanserli hastalarda yüksek Gleason skorlu (GS) (≥7) hastalarınöngörülmesinde parmakla rektal muayene (PRM), total prostat spesifik antijen (PSA), serbest PSAyüzdesi (%f PSA) ve PSA dansitesinin (PSAD) önemini araştırmak.Yöntem ve gereçler: Klinik lokalize prostat kanseri nedeniyle radikal prostatektomi yapılmış olan 225hasta çalışmaya dahil edildi. Hastalar radikal prostatektomi GS’larına göre 2 gruba ayrıldı; grup 1 GS< 6 (n = 170), grup 2 GS ≥ 7 (n = 55) hastalardan oluştu. İki grup yüksek Gleason skorununöngörülmesinde potansiyel değişkenler olan hasta yaşı, transrektal ultrason ile hesaplanan prostatvolümü (Vp), PRM, PSA, % fPSA ve PSAD açılarından karşılaştırıldı.Bulgular: Grup 1 ve 2’nin ortalama yaş, PSA, % fPSA ve PSAD’leri sırasıyla; 65,23 ± 7,7 ve 65,05 ±7,1 yıl, 11,20 ± 9,2 ve 11,09 ± 6,8 ng/mL, 16,2 ± 8,6 ve 15,5 ± 8,1, ve 0,25 ± 0,20 ve 0,28 ± 0,18ng/mL/cc idi. İki grup ortalama yaş, PSA, % fPSA ve PSAD açılarından benzerdi (tümü için P >0,05). Grup 2’de yer alan hastaların ortalama prostat volümü grup 1 ile karşılaştırıldığında istatistikselolarak anlamlı şekilde küçüktü (43,1 ± 17,01 ve 46,9 ± 17,6 mL, P = 0,043). Grup 2’deki anormalPRM’li hasta yüzdesi grup 1’den istatistiksel olarak anlamlı olarak daha azdı (% 72,7 ve % 51.2, P =0,005). Çoklu logistik regresyon analizine göre yüksek GS’unu öngörmede sadece anormal PRMbağımsız bir faktördü. PRM’de kanser şüphesi olması yüksek GS riskini 2,82 kat arttırmaktadır.Sonuç: Klinik lokalize prostat kanserli hastalarda anormal PRM yüksek GS’unu (GS ≥ 7) öngörmedebağımsız bir göstergedir.

Anahtar Kelimeler:

Parmakla rektal muayene, Gleason skor, prostat kanseri, radikal prostatektomi

An abnormal digital rectal examination is an independent predictor of high radical prostatectomy Gleason’s score ( ≥7) in patients with clinically localized prostate cancer

Aim: The aim of this study was to investigate the importance of digital rectal examination (DRE), serum total prostate specific antigen (PSA), percent free PSA (fPSA%), and PSA density (PSAD) in the prediction of high radical prostatectomy Gleason’s scores (GSs) ≥ 7 in patients with clinically localized prostate cancer. Materials and methods: Two hundred twenty-five patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the study. The patients were grouped with respect to their radical prostatectomy GSs: group 1 including the patients with GSs < 6 (n = 170) and group 2 including the ones with GSs ≥ 7 (n = 55). The groups were compared with respect to potential predictors of a high GS, which were patient age, gland volume (Vp) obtained by transrectal ultrasound, DRE, PSA, fPSA%, and PSAD. Results: The mean age, PSA, fPSA%, and PSAD values of groups 1 and 2 were 65.23 ± 7.7 and 65.05 ± 7.1 years, 11.20 ± 9.2 and 11.09 ± 6.8 ng/mL, 16.2 ± 8.6 and 15.5 ± 8.1, and 0.25 ± 0.20 and 0.28 ± 0.18 ng/mL/cc, respectively. The groups were similar with respect to mean age, PSA, fPSA%, and PSAD (P > 0.05 for all). Mean prostate volume of patients in group 2 was significantly lower than that of patients in group 1 (43.1 ± 17.01 vs. 46.9 ± 17.6 mL, P = 0.043), and group 2 had more patients with abnormal DRE findings (72.7% vs. 51.2%, P = 0.005). DRE was the only independent factor for predicting high GS in multivariate logistic regression analysis. A DRE suspicious of prostate cancer increased the high GS risk by 2.82 times. Conclusion: This study shows that an abnormal DRE is an independent predictor of high grade disease (GS ≥ 7) in patients with clinically localized prostate cancer.

Keywords:

prostate cancer , radical prostatectomy, Digital rectal examination, Gleason’s score,

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