Stage B,Cに対する前立腺全摘除術の治療成績

Abstract

臨床病期stage B, Cの前立腺癌と診断され, neoadjuvant療法を受けずに前立腺全摘除術を施行された56例を対象に, 術前後における組織学的分化度・病期の一致率, 組織学的分化度と前立腺特異的抗原(PSA)の関係などを検討した.術前後の組織学的分化度・病期の一致率は各々58.9%, 23.2%と低かった.癌が前立腺に限局している9例ではいずれも術前のPSAが30ng/ml以下であり, 術前の組織学的分化度は高分化5例, 中分化2例, 低分化2例, 術後は高分化2例, 中分化7例であった.術後のPSA半減期は低分化例とリンパ節転移陽性例で有意な延長を認めた.adjuvant療法を受けていない症例のPSA半減期延長はPSA再発を示唆する可能性が考えられた.術後の組織学的分化度別5年非癌死率は, 高分化93%, 中分化97%, 低分化87%と有意差はみられなかった

There has been much controversy regarding radical surgery for both localized and locally extensive carcinoma of the prostate. We analyzed the outcome of radical prostatectomy and the preoperative evaluation in order to assess the indication of radical prostatectomy. Fifty-six patients with clinical stage B or C prostate cancer were treated by radical prostatectomy without neoadjuvant therapy. Endocrine therapy was added to the non-curative cases postoperatively. Preoperative evaluation was compared with pathological results and survival, and furthermore the usefulness of the preoperative PSA and PSA half-life were investigated. The mean follow-up period was 44.5 months. The accuracy of the grade and the clinical stage were 58.9% and 23.2%, respectively. Organ-confined disease was seen in patients with an initial PSA level less than 30 ng/ml. Postoperative PSA half-life is significantly prolonged in cases with poorly differentiated adenocarcinoma or lymph node involvement and may be a predictor of PSA failure. The cause-specific 5-year survival rates were 92.7% on the whole, 92.9% for well differentiated, 96.7% for moderately differentiated, 85.7% for poorly differentiated, 100% for stage B1, 95.0% for stage B2 and 86.8% for stage C. These results indicated that patients with an initial PSA level of less than 30 ng/ml will benefit from radical prostatectomy.