根治的前立腺摘除術におけるPSA failureについての臨床的検討

Abstract

Between January 1996 and December 2007, 111 patients with prostate cancer underwent radical prostatectomy, including 34 who received preoperative hormonal therapy. In this study, we reviewed 77 patients who did not undergo neoadjuvant hormonal therapy. The mean age was 65.5 years old and followup time was 40.7 months. The clinical stage was T1c in 60 patients, T2 in 16, and T3 in 1. Prostate specific antigen (PSA) at diagnosis ranged from 3.44 to 46.08 ng/ml (mean 10.18). At our institution, PSA failure after surgery was defined as PSA elevation above 0.2 ng/ml. The pathological stage was pT2 in 59 patients, pT3a in 11, pT3b in 7 and pN + (obturator lymph node) in none. The surgical margin was positive in 29.3% of the pT2 patients and 68.8% of the pT3 patients. Sixteen patients (20.8%) had PSA failure. PSA values at diagnosis and pathological T stage were significantly relevant to PSA failure. Patients with PSA failure underwent radiation therapy or hormonal therapy as a salvage adjuvant therapy. The PSA level was controlled well in majority of the patients. Only one patient died of cancer. In conclusion, 33 out of 111 patients who underwent radical prostatectomy had PSA failure. Sixteen of the 77 patients who were not given neoadjuvant therapy had PSA failure. The significant factors related to PSA failure were PSA values at diagnosis and pathological T stage.

過去12年間に111症例に根治的前立腺摘除術(手術時平均年齢65.5歳)を施行し、そのうち術前治療を行わなかった77症例について検討し、術後 PSA failureに関連する因子について検討した。術前PSAは平均10.18ng/ml、病理学的病期はpT2cが最も多かった(57.1%)。77例中術後PSA failureとなったのは16例(20.8%)で、追加治療として早期に外照射、内分泌治療を行った。平均観察期間は40.7ヵ月で、PSA failureは約20ヵ月まで起こっていた。PSA failureについて術前の患者背景や病理学的因子との相関を検討したところ、対象77例においてPSA failureと相関があったのは診断時のPSA値、pathological T stageであり、診断時のPSAが高いほど有意にPSA failureは多くなった。臨床病期はpT2、pT3a、pT3bの3群におけるPSA failure free survivalでは、pTが進むにつれて有意にPSA failureを起こした。以上より、患者背景とPSA failureは診断時のPSAとpT stageが相関していた。