원격전이없이 술 전 Prostate-Specific Antigen (PSA) 20 ng/ml 이상인 전립선암 환자에서의 근치적 전립선적출술의 결과
Outcome of Radical Prostatectomy in Prostate Cancer Patients with Prostate-Specific Antigen (PSA) Level Equal to or More Than 20 ng/ml and No Distant Metastasis Preoperatively
함원식, 이주형, 이진선, 김상운, 최영득,
소속 상세정보
함원식 ( Ham Won-Sik )
연세대학교 의과대학 비뇨기과학교실, 비뇨의과학연구소
이주형 ( Lee Joo-Hyoung )
연세대학교 의과대학 비뇨기과학교실
이진선 ( Lee Jin-Sun )
연세대학교 의과대학 비뇨기과학교실
김상운 ( Kim Sang-Woon )
연세대학교 의과대학 비뇨기과학교실, 비뇨의과학연구소
최영득 ( Choi Young-Deuk )
연세대학교 의과대학 비뇨기과학교실, 비뇨의과학연구소
KMID : 0358320090500020111
Abstract
Purpose: We assessed the efficacy of radical prostatectomy (RP) in prostate cancer patients with preoperative prostate-specific antigen (PSA) levels ≥20 ng/ml and no distant metastases.
Materials and Methods: The records of 132 prostate cancer patients undergoing RP with preoperative PSA levels ≥20 ng/ml and no distant metastases were reviewed. Sixty-six patients received preoperative neoadjuvant hormonal therapy. Pathologic and clinical outcomes were compared between the groups with PSA of 20-40 ng/ml and ≥40 ng/ml.
Results: There were no statistical differences in age, prostate volume, or the frequency of neoadjuvant hormonal therapy between the two groups. The PSA ≥40 ng/ml group had a higher RP Gleason score, tumor stage, and extracapsular extension. After a mean follow-up of 47.0 months, 73 (55.3%) patients had PSA progression with a median time of 37.0 months. Fifty-six patients received adjuvant hormonal therapy, and 19 received salvage external beam radiation therapy. Clinical disease progression developed in 10 patients (7.6%). During follow-up, 8 patients died, 1 of prostate cancer and 7 of other causes. Preoperative PSA was a significant predictor of PSA progression and time to PSA progression after RP, whereas there were no differences in distant metastasis, local recurrence, hormone-refractory prostate cancer progression, and overall or prostate cancer-specific death between the 2 groups.
Conclusions: On the basis of the favorable postoperative outcomes of RP in patients with preoperative PSA ≥20 ng/ml and no distant metastases, we suggest that RP has a role in treating these high-risk prostate cancer patients and that preoperative PSA is a significant predictor of postoperative PSA progression. (Korean J Urol 2009;50:111-118)
키워드
Prostate-specific antigen;Prostatic neoplasms; Prostatectomy;Treatment outcome
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