Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: analysis and results of an ongoing prospective multicentre study at 3 years
Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: analysis and results of an ongoing prospective multicentre study at 3 years
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DOI：
10.1111/j.1464-410x.2006.06197.x
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发表时间：
2006-06-01
影响因子：
4.5
通讯作者：
Hais, MA
中科院分区：
文献类型：
--
作者：
Te, AE;Malloy, TR;Hais, MA
高功率磷酸钾钛酸盐（KTP）激光前列腺切除术安全有效地汽化了良性前列腺增生（BPH）后继发的前列腺腺瘤，在此基础上，分析治疗前前列腺总特异性抗原（tPSA）水平和前列腺体积是否能预测光选择性汽化前列腺切除术（PVP）治疗梗阻性良性前列腺疾病的临床疗效。出血少，发病率低。患者和方法2001年10月至2003年1月，在6个研究中心，139名男性（平均年龄67.7岁，SD 8.7）诊断为BPH继发的下尿路梗阻性症状，PVP平均KTP激光能量为80 W。进行了一项亚分析，评估PVP前每位患者的tPSA和前列腺体积，并对PVP后3年的主要疗效结果进行了长期评估。根据tPSA水平（1组，= 6.1 ng/mL），将每位患者分为两个亚组之一，并分别进行评估。评估每个亚组在PVP后1、2和3年的美国泌尿症状指数（AUA SI）评分、生活质量（QoL）评分、峰值尿流率（Q(max)）、前列腺体积和空隙后残留尿量（PVR）与基线的变化。结果所有tPSA亚组的疗效均持续改善3年。1、2、3年时各组患者AUA SI、Q（max）改善水平比较，差异均有统计学意义（P < 0.05）。组1平均前列腺体积（SD）为48.3 (16.7)mL（87人），组2平均前列腺体积（SD）为83.1 (30.6)mL（52人）。1组和2组在1、2和3年时AUA SI的平均改善百分比分别为86%、92%和85%，以及69%、74%和76%；相应的Q（max）改善百分比分别为194%、185%和179%，124%、145%和139%。所有患者的总体治疗效果评估显示，AUA SI、QoL、PVR和Q（max）分别平均改善83%、79%、71%和165%。不良事件最少，再治疗率为4.3%。结论PVP前tPSA = 6.1 ng/mL患者疗效差异有统计学意义。然而，无论tPSA水平和前列腺体积如何，PVP的总体结果都是非常积极和持续3年的。
Objective To report the 3-year results and analyse whether total prostate-specific antigen (tPSA) levels and prostate volume before treatment can predict the level of clinical efficacy of photoselective vaporization prostatectomy (PVP) for treating obstructive benign prostatic disease, as high-power potassium-titanyl-phosphate (KTP) laser prostatectomy was previously shown to be safe and to efficiently vaporize prostatic adenoma secondary to benign prostatic hyperplasia (BPH), with minimal bleeding and morbidity.Patients and Methods From October 2001 to January 2003, 139 men (mean age 67.7 years, SD 8.7) diagnosed with obstructive lower urinary tract symptoms secondary to BPH, had PVP with an average 80 W of KTP laser energy, at six investigational centres. A subanalysis evaluating each patient for tPSA and prostate volume before PVP was conducted, with a long-term assessment of the primary efficacy outcomes at 3 years after PVP. Each patient was assigned to one of two subgroups according to the tPSA level (group 1, = 6.1 ng/mL) and evaluated separately. Each subgroup was assessed for changes from baseline in American Urological Symptom Index (AUA SI) score, quality of life (QoL) score, peak urinary flow rate (Q(max)), prostate volume, and postvoid residual urine volume (PVR) at 1, 2 and 3 years after PVP.Results All tPSA subgroups had a sustained improvement in all efficacy outcomes maintained through the 3 years. There was a statistically significant difference in the level of improvement between groups 1 and 2 (P < 0.05) in AUA SI and Q(max) at 1, 2 and 3 years. The mean (SD) prostate volume for group 1 was 48.3 (16.7) mL (87 men), and was 83.1 (30.6) mL (52 men) in group 2. The mean percentage improvement in the AUA SI at 1, 2 and 3 years in group 1 and 2, respectively, was 86%, 92% and 85%, and 69%, 74% and 76%; the corresponding percentage improvement in Q(max) was 194%, 185% and 179%, and 124%, 145% and 139%, respectively. Overall treatment efficacy in all patients evaluated showed a mean 83%, 79%, 71% and 165% improvement in AUA SI, QoL, PVR and Q(max), respectively. Adverse events were minimal and the re-treatment rate was 4.3%.Conclusion These results suggest that there is a significant difference in efficacy in patients with a tPSA of = 6.1 ng/mL before PVP. However, the overall results achieved with PVP were very positive and durable to 3 years, irrespective of tPSA level and prostate volume.