[Clinical study of radical prostatectomy for prostate cancer from a single institution].
OBJECTIVE
To investigate the outcomes for single institution with prostate cancer treated with radical prostatectomy (RP).


METHODS
A retrospective analysis was performed on 406 patients who underwent RRP from January 1991 to December 2005 for cT1-3N0M0 prostate cancer. To evaluate the change of the patient background, we divided the 15 years into the 5 periods whose span was 3 years each and examined. Biochemical recurrence was defined as a prostate-specific antigen (PSA) of > or = 0.2 ng/ml. Clinical recurrence was defined as metastases or local recurrence. Actual probability of cancer specific mortality was estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Preoperative parameters analyzed were patient age, preoperative PSA, clinical stage, Gleason score, and Neoadjuvant hormonal therapy. Multivariate analyses (logistic regression and Cox proportional hazard model) for the dependent variables (organ-confined prostate cancer, clinical recurrence free survival and cancer specific mortality) were performed. Perioperative complications between cT1/2 with cT3 were compared.


RESULTS
The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Median follow-up and median patient age were 55 month and 69 year. Of the 406 men, 35 (8.6%) developed clinical recurrence, 15 men (3.7%) died from prostate cancer within the follow-up period. For pT0/2, pT3a, pT3b and pN +, the 10-yr cancer specific survival rate was 100%, 92%, 81% and 67%, respectively. Preoperative PSA (p < 0.0001), clinical stage (p = 0.004), Gleason score (p < 0.0001) and neoadjuvant hormone therapy (p = 0.0003) are predictive variables for organ confined prostate cancer. Preoperative PSA (p = 0.002) and clinical stage (p = 0.03) are prognostic variables for cancer specific mortality. There was significant difference in surgery time (p = 0.04) and blood loss (p = 0.0007) in cT1/2 cases compared with cT3 cases.


CONCLUSIONS
The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Neoadjuvant hormone therapy prior to prostatectomy was a significant improvement in the organ confined rates. However neoadjuvant hormone therapy did not improve patient prognosis. Preoperative PSA and clinical stage are prognostic variable for cancer specific mortality.
Ishida
Ryo
R
Nagoya Daini Red Cross Hospital, Department of Urology.
Kobayashi
Hiroaki
H
Yoshida
Shinri
S
Ogawa
Masahiro
M
Shiota
Takako
T
Nishikimi
Toshinori
T
Yamada
Hiroshi
H
Yokoi
Keisuke
K
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
D018931:Antineoplastic Agents, Hormonal