ABSTRACT
OBJECTIVE: The effect of prostate volume on the surgical, functional, and oncological outcomes of robot assisted radical prostatectomy (RARP) was evaluated. MATERIAL AND METHODS: A total of 180 patients who underwent RARP and had at least a 1-year follow-up were included. The patients were divided into 3 groups based on prostate weight (Group 1: <45 g, Group 2: 45-75 g, and Group 3: >76 g). Erectile function and continence were evaluated at 3, 6, 9, and 12 months postoperatively. The International Index of Erectile Dysfunction (IIEF) score and daily pad usage were evaluated as indicators of erectile function and continence, respectively. The measurement of two prostate-specific antigen (PSA) values over 0.2 ng/mL was considered biochemical disease recurrence. RESULTS: Patients with larger prostates were older and had a longer operative time and higher PSA level compared with patients with smaller prostates (p<0.05). The positive surgical margin rate was higher in patients with smaller prostates (p=0.06). However, patients with a prostate weight <45 g had higher IIEF scores at 3 and 6 months. IIEF scores were similar at the end of the 1-year follow-up period. Pad usage and time to continence were higher in patients with larger prostates (p>0.05). CONCLUSION: Although prostate weight affected the surgical outcomes of RARP, the functional and oncological outcomes were similar among all patients. Long-term follow-up is needed to determine their impact on oncological outcomes.
ABSTRACT
OBJETIVOS: Investigamos la asociación entre el porcentaje de afectación de los cilindros de biopsia y los parámetros clínicos preoperatorios, y la evolución del cáncer de próstata en una cohorte de pacientes con cáncer de próstata localizado intervenidos mediante prostatectomía radical retropúbica (PRR) de forma consecutiva. METODOS: Análisis retrospectivo de los datos de 203 pacientes con cáncer de próstata clínicamente órganoconfinado intervenidos de PRR entre Marzo de 1993 y Mayo del 2004. Se analiza la correlación del PSA preoperatorio, el Gleason en la biopsia, el número total de biopsias positivas y el porcentaje de afectación en la biopsia con la extensión de la enfermedad en el estudio anatomopatológico final y la progresión bioquímica. RESULTADOS: El porcentaje medio de afectación de los cilindros fue de 29,8 ± 21,1 (mediana 25). El análisis anatomopatológico de los especimenes quirúrgicos reveló extensión extracapsular en 66 casos (32,5%), invasión de las vesículas seminales en 43 (21,2%), afectación ganglionar en 8 (4%) y márgenes quirúrgicos positivos en 59 (29,1%). Globalmente, sólo el 9% de los pacientes (18 de 203) presentaron progresión bioquímica con un tiempo medio de seguimiento de 22 meses. El análisis univariante reveló que el Gleason en la biopsia, el número de cilindros afectos y el porcentaje de afectación eran factores predictivos de enfermedad extraprostática en el espécimen de la PRR. Sin embargo, en el análisis multivariante el Gleason y el PSA sérico eran los factores predictivos independientes más potentes de enfermedad extraprostática, mientras que el porcentaje de afectación de las biopsias tenia significación en la predicción de extensión extracapsular y márgenes positivos. El número de cilindros no fue predictivo de enfermedad extraprostática. El PSA preoperatorio fue el único factor pronóstico para la determinación de progresión bioquímica. CONCLUSIONES: La puntuación de Gleason es el factor independiente más importante en la predicción de enfermedad extraprostática. El porcentaje de los cilindros positivo para cáncer sólo tiene significación en la predicción de extensión extracapsular y márgenes quirúrgicos positivos. Son necesarios más estudios antes de utilizar rutinariamente el porcentaje de afectación de los cilindros como uno de los factores pronósticos preoperatorios importantes
OBJECTIVES: In this study, we investigated the association of positive biopsy core percent (PBCP), as well as other preoperative factors, with prostate cancer outcomes in a cohort of consecutive patients with clinically localized prostate cancer who underwent RRP. METHODS: Data from 203 patients who underwent RRP from March 1993 to May 2004 for clinically organ confined prostate cancer was analysed. The correlation of preoperative serum prostate specific antigen (PSA) level, biopsy Gleason score, total number of positive biopsies and PBCP with the extent of disease at final pathology and biochemical progression were analyzed. RESULTS: The mean PBCP was 29.8+/-21.1 (median 25). Histopathological examination of the RRP specimens revealed ECE in 66 (32.5 %), SVI in 43 (21.2 %), LNI in 8 (4 %), and positive SM in 59 (29.1 %). Overall, only 9% of patients ( 18 of 203) had biochemical progression at a median postoperative follow-up of 22 months. Univariate analysis revealed serum PSA, biopsy Gleason Score, the number of positive cores and PBCP as predictive factors for extra-prostatic disease in RRP specimens. However, multivariate analysis revealed that biopsy Gleason score and serum PSA were the strongest independent predictive factors for extra-prostatic disease while percent positive biopsy cores carried significance in the prediction of ECE and SM positivity. The number of positive cores was not a predictor of non-organ confined disease. Preoperative serum PSA was the only prognostic factor for determination of biochemical failure. CONCLUSION: Gleason score is the most important and independent predictive factor for extra-prostatic disease. The percentage of cores positive for cancer has significance only in the prediction of ECE and SM positivity. Further studies are needed before routine use of PBCP as one of the important preoperative prognostic factors
