臨床病期B, Cにおける前立腺全摘除術の治療成績とその解析

Abstract

臨床病期B, Cの診断にて根治的前立腺全摘除術を施行した40例の治療成績について検討した.prostate-specific antigen(PSA)failureを4例, 癌死を1例認め, 5年癌特異的生存率は91.7%, 5年非再発率(PSA failure-free rate)は76.8%であった.術前診断がorgan-confined disease(OCD)で術後病理学的にnon-OCDであった症例が41.7%に認められた.術前PSA値が20.1ng/ml以上の症例は術前PSA値が20ng/ml以下の症例と比べて有意に病理学的non-OCDとリンパ節転移が多く, 断端浸潤と精嚢浸潤についても多い傾向にあった.又, 病理学的OCD症例ではnon-OCD症例に比べて術前PSA値が有意に低値であった.術前PSA値が20ng/ml以上をnon-OCDの条件とすることで, MRI及びCT単独による病期診断に比べてより正確な術前病期診断のできる可能性が示唆された

Between 1989 and 1999, 40 patients treated with radical prostatectomy for clinical stage B and C prostate cancer were analyzed. Prostate-specific antigen (PSA) failure after radical prostatectomy occurred in four patients, and one of them died of clinical recurrence of prostate cancer. Cause-specific survival at 5 years was 91.7% and PSA failure-free rate at 5 years was 76.8%. Staging accuracy of CT and MRI image was not satisfactory. In 41.7% patients, extracapsular extension can not be determined. Preoperative serum PSA levels of pathologically organ-confined disease (OCD) patients were significantly lower than those of pathologically non-OCD patients. Further analysis indicated that preoperative serum PSA levels of greater than 20.1 ng/ml are useful predictors for pathologically non-OCD.