病期C前立腺癌に対する前立腺全摘除術の治療成績 : 他治療法との比較検討

Abstract

75歳以下の病期C69例について解析した. 1)非再発率の検討より, 高, 中分化癌かつT3a～c(低リスク群)と低分化癌或いはT4a(高リスク群)の2群に分けることができた. 2)前立腺全摘除術+内分泌療法は29例, 放射線療法+内分泌療法21例, 及び内分泌療法単独19例で, 放射線療法群に低分化癌が多い傾向があり, 内分泌療法単独群にT4aのhigh stage症例が多かった. 3)低リスク群で前立腺全摘除術による再発, 再燃症例はなく, 前立腺全摘除術の最もいい適応と考えられた. 4)高リスク群では前立腺全摘除術は放射線療法に比較し再発, 再燃率は高く, 放射線療法が適応である

Of the 69 patients with clinical stage C prostate cancer under 75 years old and with good performance status between 1986 and 1995, 29 underwent radical prostatectomy combined with endocrine therapy, 21 underwent radiation therapy combined with endocrine therapy and remaining 19 patients were treated by endocrine therapy alone. The median followup was 44 months (range 4 to 122). Radical prostatectomy resulted in progression-free rates of 79% and 61% at 5 and 10 years, respectively. Progression-free rates were lower in patients with lymph node metastasis or positive surgical margins. In patients with clinical stage T3a-c and well or moderately differentiated tumor, radical prostatectomy resulted in a progression-free rate of 100% at 5 years. However, in patients with clinical stage T4a or poorly differentiated tumor, radiation therapy resulted in a better progression-free rate than radical prostatectomy. These findings suggest that patients with clinical stage T3a-c and well or moderately differentiated tumor will benefit from radical prostatectomy combined with endocrine therapy and that radiation therapy well be effective for advanced diseases.