进展期前列腺癌外科治疗25例临床分析

目的 探讨进展期前列腺癌的外科治疗.方法 回顾性分析2014年5月至2016年2月于本院收治的予以手术处理的25例进展期前列腺癌的患者临床资料,统计其年龄、术前PSA、病理分期、前列腺体积及术后PSA最低值和随访结果.结果 25例进展期前列腺癌患者平均年龄为68.1岁(56 ～ 83岁),术前PSA15.81～335 ng/mL,10例患者术前PSA大于100 ng/mL,术前PSA平均86 ng/mL.临床分期T3bN0期8例,N1期13例.临床诊断骨转移4例,这4例患者病理为2例T3bN0、2例T4N1.Gleason评分7分7例,≥8分18例.前列腺体积平均67.2 mL(50～145 mL),19例行腹腔镜下前列腺切除+扩大盆腔淋巴结清扫,6例为开放手术,术中清除淋巴结平均13枚(4～30枚),淋巴结平均转移率20％ (0％ ～94％).围手术期3例患者需要输血,1例患者引流管拔管延迟,未见其他重大并发症.外科手术后6周复查PSA明显降低,平均值1.20 ng/mL(0.32 ～ 4.60 ng/mL),外科治疗后3个月PSA降至平均0.08 ng/mL(0.003 ～0.450 ng/mL).随访时间5～23个月,所有患者目前均存活.1例患者出现生化复发,MRI检查及进一步经尿道膀胱肿物切除手术确诊为复发,电切病理同根治手术均为Gleason评分4+5 =9分;余患者目前PSA控制满意.结论 进展期前列腺癌外科处理是一种安全的治疗方式,前列腺切除+扩大淋巴结清扫并未见并发症明显升高,对于严格筛查入选的患者行外科治疗是控制肿瘤的一种合理方式.

Clinical analysis of advanced prostate cancer treated by surgery in 25 patients

Objective To investigate surgical treatment for advanced prostate cancer.Methods We retrospectively reviewed 25 cases of advanced prostate cancer treated by surgery between May 2014 and February 2016.The general data of the patients were analyzed.And age,PSA before surgery,pathological stage,prostate volume,fluctuation of postoperational PSA and outcome were recorded.Results The average age of the patients was 68.1 (56 ～ 83) years old,mean PSA before surgery was 86(15.81 ～ 335) ng/mL.There was 7,18 patients with Gleason score of 7 and ≥8 respectively.Of those patients,8 of them were staged T3bN0,13 of them were TxN1 M0,4 patients had putative bonenetastases and were staged M1b c1inically.Mean volume of the prostate was 67.2(50 ～ 145) mL,19of them were treated by laproscopic radical prostatectomy,6 patients was treated by open retropubic surgery.Extended lymphatic dissection were performed,4 ～30 lymph nodes with an average of 13 were extirpated.Three patients need transfusion after surgery,1 patient experienced delayed drainage withdraw because of lymphorrhea,no major complication was found.PSA decreased significantly after surgery,mean PSA level dropped to 1.2(0.32 ～4.6) ng/mL at 6 weeks after operation,and then to 0.08 (0.003 ～0.450)ng/mL at 3 months after surgery.The patients were followed up for 5 ～23 months,none of them died.One patient experienced biochemical relapse,MRI showed relapse in the urethrovesical anastomosis and was treated by endoscopic resection and comfirmed to be prostate cancer relapse with the same Gleason score of 9 as the former pathological diagnosis.Conclusions Surgery is a safe modality to treat advanced prostate cancer,radical prostatectomy and extended lymph node dissection didnt necessarily mean higher risk of complication.In experienced hands,radical prostatectomy and extended lymph node dissection is a rational choice for selected patients.