Diagnosticul ǎi tratamentul cancerului de prostatâ în stadiul localizat

Ambert, V.; Braticevici, B.; Damian, D.; Chira, I.; Jinga, V.; Iconaru, V.; Radu, T.; Constantin, T.
September 2010
Romanian Journal of Urology;Sep2010, Vol. 9 Issue 3, p23
Academic Journal
Introduction: The discovery of prostate specific antigen (PSA) and the use of serum markers represented a step forward in the diagnosis of prostate cancer (PC). Based on substantial clinical experience in diagnosis and treatment of PC (1442 PC cases admitted in our clinic during 2005-2009 and over 90 radical prostatectomies) of the team of urologists in the Clinic of Urology of "Prof. Dr. Th. Burghele" Clinical Hospital, this paper brings forward the main technical aspects of prostate biopsy (PBP), surgical technique used, complications of intra / postoperative and analyze the short term results. The main objective of this study is to present our experience in an area where the number of cases of PC radically operated at national level is still very small. Methods: in a period of 10 years, 01/01/1999 - 12/31/2009, in our clinic, 123 patients with CP aged 48-74 years were operated using the radical prostatectomy (RP). The indication for prostate biopsy (PBP) consisted in PSA values that exceeded the maximum of 4 ng / ml, in the beginning of the study and in recent years, 2.5 ng / ml. PBP consisted in, at first, into prostate punctures ultrasound "targeted" especially in suspicious areas, then regardless of TRUS aspect we used the randomized biopsy, with a number of punctures correlated to prostate volume (minimum 6, max 12). In most cases we performed 10 biopsies. Classification, based on the clinical stage of the 123 operated patients was: T1 cT1 - 77 cases, T2 cT2a - 25 cases; cT2b - 15 cases; ≥cT3 - 6 cases. We used the classic RP technique, described by P.C.Walsh, lymphadenectomy always representing the first time surgical. Results: From all the patients operated for PC, in our records, at least 3 years after the operation, there are still 43 cases. At 1-2 years we still have in evidence 45 patients. We can appreciate that, among patients followed for a minimum of 3 years postoperatively, 70 patients (57%) with PC can be considered cured because they needed no other therapy and their PSA remained below 0.02 ng / ml. For the patients with a postoperative follow-up period shorter than 3 years, in 78.3% cases the serum PSA values were maintained below 0.02 ng / ml. Related to Gleason score, in 48% cases there was concordance between biopsy and RP piece, in 39% cases the puncture fragments had a lower score compared to RP piece and at 13% of the patients there was higher score; the most common cause of discrepancy was sampling error. The histological correlation between preoperative clinical stage and the pathologic clinical stage appreciated on the piece of RP was 57%. The most important late postoperative complications of RP were urinary incontinence and erectile dysfunction. In our group, after over a year of surveillance, the total urinary incontinence was recorded in 11 cases (8.9%). Erection was maintained after bilateral preservation of bandelets in 59% of patients and in 22% of cases after unilateral preservation of bandelets. At one year after the intervention only 66% of all our patients, had the potency preserved. Due to the short follow-up interval we cannot say that our operated patients had a benefit in terms of overall survival.


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