Ersin Erdinç ÇELEBİ, Zülfü SERTKAYA, Musa Ali KUTLUHAN, Selçuk KABA, Metin ÖZTÜRK, Muhammet İhsan KARAMAN

Prostat Kanserli Yaşlanan Erkekte Palyatif Bakım Kararı

Amaç: Çalışmamızın amacı, prostat kanserinde hastanın geliş hasta yaşı ve PSA değeri ilepalyatif yaklaşım veya küratif tedavi kararının verilebileceğini göstermektir.Gereç ve Yöntemler: 2007 ve 2012 kliniğimizde prostat kanseri tanısı almış hastalar retrospektif olarak tarandı. Hastaların yaşı, prostat hacimleri, transrektal ultrasonografi eşliğinde prostat biyopsi sonuçları, metastaz taraması için yapılan görüntülemeleri ve radikal prostatektomi yapılan hastaların patoloji sonuçları kaydedildi.Bulgular: Hastaların yaş ortalaması 70.85 ± 8.40 idi. Ortalama yaş, PSA seviyeleri, yüzde kadran oranları ve Gleason skorları metastaz varlığına bağlı olarak anlamlı farklılık gösterdi (p<0.01). Bir hastada prostat kanseri varlığı açısından, 75 yaş kesme değerinde özgüllük % 77,17, duyarlılık % 68,18, pozitif öngörü değeri (PPV) % 48,28, negatif öngörü değeri (NPV) % 88,58 ve doğruluk % 70,68 idi; 20 PSA kesme noktasında duyarlılık % 92,13, özgüllük % 91,52, PPV % 80,69, NPV % 96,79 ve doğruluk % 91,68 idi; 0,41 Çeyreksel kesme değerinde, özgüllük % 75,59, PPV % 52,17, NPV % 88,64 ve duyarlılık % 73,96 idi.Sonuç: Geriatrik yaş grubunda, palyatif bakım veya küratif tedavi kararında hastaların yaş ve PSA değeri değerlendirilerek hasta yönetiminde karar verilmelidir.

Anahtar Kelimeler:

Prostat kanseri, palyatif bakım, metastaz, yaşlanan erkek

Palliative Care Decision in Aging Male With Prostate Cancer

Objective: The aim of our study is to demonstrate that differentiating patients receiving a palliative approach to prostate cancer from candidates for definitive treatment using age and PSA value at initial presentation.Material and Method: The records of patients diagnosed with prostate cancer in our clinic and external centers and presenting to our clinic for treatment between 2007 and 2012 were examined retrospectively. Information was collected concerning patients’ ages at presentation, presentation PSA values, rectal examination findings at time of presentation, prostate volumes, transrectal ultrasonography (TRUS)-guided prostate biopsy results, imaging findings performed for staging purposes in patients with prostate cancer, and pathological specimens in operated patients..Results: Mean age of patients was 70.85±8.40. Mean ages, PSA levels, percentage quadrant rates, and Gleason scores differed significantly depending on presence of metastasis (p<0.01). In terms of the presence of prostate cancer in a patient, at a cut-off value of age 75, specificity was 77.17%, sensitivity 68.18%, positive predictive value (PPV) 48.28%, negative predictive value (NPV) 88.58%, and accuracy 70.68%; a PSA cut-off point of 20 exhibited sensitivity of 92.13%, specificity of 91.52%, PPV of 80.69%, NPV of 96.79%, and accuracy of 91.68%; and also sensitivity at a percentage of quadrant cut-off value of 0.41, specificity was 75.59%, PPV 52.17%, NPV 88.64%, and accuracy 73.96%.Conclusion: Decision in management should be made by evaluating age and PSA value whether to apply palliative care or curative treatments in the geriatric age group without performing a biopsy.

Keywords:

Prostate cancer, palliative care, metastasis, aging male,

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