Clinicopathological outcome of radical retropubic prostatectomy for 200 men with prostate cancer in a single institution in Japan

Abstract

兵庫県立成人病センター開設以来, 前立腺癌に対して根治的恥骨後式前立腺全摘除術を施行した200症例の臨床病理学的検討を行った.その結果, 経過観察期間中に, 癌死4例および他因死11例を認めた.また, 生化学的再発をPSA>0.4ng/mlと定義すると, この間に23例(11.5%)に生化学的再発を認めた.5年生化学的非再発率, 疾患特異的生存率および全生存率は, それぞれ83.6, 97.7%および91.4%であった.多変量解析の結果, リンパ節転移の有無および臨床病期が, それぞれ疾患特異的生存率および全生存率の独立した予後規定因子であった.以上より, 局所進行性症例を含む手術可能な前立腺癌症例に対し, 根治的前立腺全摘除術を中心とした治療は良好な長期予後が得られることが示唆された

The objective of this study was to retrospectively evaluate the clinicopathological outcome of radical retropubic prostatectomy (RRP) performed at a single institution in Japan. A consecutive series of 200 patients with prostate cancer who underwent RRP and pelvic lymphadenectomy between March 1985 and April 2003 were included in this study. The median age at RRP and the observation period were 69 years old and 43 months, respectively. Clinicopathological findings were reviewed to determine parameters providing predictive information about biochemical recurrence-free, cause-specific, and overall survivals. The pathological stage was pT0 in 7 patients (3.5%), pT2a in 43 (21.5%), pT2b in 58 (29.0%), pT3a in 42 (21.0%) pT3b in 36 (18.0%), and pT4 in 14 (7.0%). Lymph node metastasis was detected in 32 of 200 patients (16.0%). Forty-seven patients (23.5%) received neoadjuvant hormonal therapy, while 48 (24.0%) underwent hormonal therapy alone or hormonal therapy plus radiotherapy following RRP as an adjuvant treatment. During the observation period, 4 patients (2.0%) died of prostate cancer, 11 (5.5%) died of other diseases and biochemical recurrence occurred in 23 (11.5%), when biochemical recurrence was defined as prostate specific antigen (PSA) persistently greater than 0.4 ng/ml. Five-year biochemical recurrence-free, cause-specific, and overall survival rates were 83.6%, 97.7% and 91.4%, respectively. Furthermore, multivariate analyses showed that lymph node metastasis or clinical stage was an independent predictive factor for cause-specific or overall survival, respectively. These findings suggest that it would be possible to achieve a favorable cancer control for patients with localized prostate cancer, including locally advanced cases, by the RRP-based combination therapies.