A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates
A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates
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DOI：
10.1046/j.1464-410x.2003.04361.x
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发表时间：
2003-09-01
影响因子：
4.5
通讯作者：
Kirby, RS
中科院分区：
文献类型：
--
作者：
Foley, CL;Bott, SRJ;Kirby, RS
旨在确定根治性耻骨后前列腺切除术 (RRP) 中大前列腺对病理结果、生化复发率、效力和节制的影响。从 440 名接受 RRP 治疗的患者的数据库中，获得了有关前列腺重量、患者和肿瘤特征以及随访的回顾性信息。使用自我报告的验证问卷获得 RRP 后的效力和节制能力。比较前列腺> 75或小于或等于75 g的患者。两组前列腺大小中位（范围）分别为87（76 - 182）和42（4.1 - 75）g。调查问卷的回复率为 78%（344 名男性）。前列腺重量 > 75 g 的患者比另一组患者年龄更大，中位年龄为 65 ( 51 - 74) 岁，为 61 ( 40 - 76) 岁 ( P = 0.01) ，并且初始前列腺特异性抗原 (PSA) 水平较高，分别为 9.6 ( 3.4 - 37.8) 和 7.6 ( 0.1 - 30.0) ng/mL （P = 0.001）。较大前列腺内的肿瘤分期较低（P = 0.035），格里森分级较低（中位数为 6 和 7，P = 0.015），体积较小（中位数为 1.0，0.1 - 12.4；和 1.5，0.1 - 21.1 mL；P = 0.04），并且更常见的是“临床意义不大”（23% 和 6%，P） = 0.001）。阳性手术切缘的数量或分布没有差异。在 20-25 个月的有限中位随访中，前列腺重量 > 75 g 的患者生化复发的可能性较小（5% vs 24%，P < 0.001）。各组之间的效能和失禁率相似。 RRP 时的前列腺大小不会影响随后出现阳痿或失禁的风险。前列腺重量 > 75 g 与 PSA 复发的可能性较低相关，这可能是由于前置时间偏差造成的。虽然前列腺肥大可能会禁忌其他可能治愈的癌症治疗，但 RRP 的结果似乎不受影响。
To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence.From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of > 75 or less than or equal to 75 g were compared.The median ( range) prostate size was 87 ( 76 - 182) and 42 ( 4.1 - 75) g in the two groups. The response rate to the questionnaire was 78% ( 344 men). Patients with prostates of > 75 g were older, with a median ( range) age of 65 ( 51 - 74) years, than the other group, at 61 ( 40 - 76) years ( P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 ( 3.4 - 37.8) and 7.6 ( 0.1 - 30.0) ng/mL, respectively ( P = 0.001). Tumours within larger prostates were of a lower stage ( P = 0.035), lower Gleason grade ( median 6 and 7, P = 0.015), of smaller volume ( median 1.0, 0.1 - 12.4; and 1.5, 0.1 - 21.1 mL; P = 0.04) and more often 'clinically insignificant' ( 23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20 25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.