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Evolution of the Clinical Presentation and Outcomes after Radical Prostatectomy for Patients with Clinically Localized Prostate Cancer – Changing Trends over a Ten Year Period

Goran Štimac
Jordan Dimanovski
Davor Trnski
Josip Katušić
Boris Ružić
Borislav Spajić
Ante Reljić
Milko Padovan
Ognjen Kraus

Puni tekst: engleski pdf 84 Kb

str. 1055-1060

preuzimanja: 400



We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate
cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance
of changes during the 10-year period.We assessed the annual trends for changes in patients age, preoperative prostate
specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical
margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency
increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage
of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological
PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ-
confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89
ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to
10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving
neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to
31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly
detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ-
confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical
stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue
strongly that routine PSA testing should be expanded and not restricted.

Ključne riječi

prostate cancer; localized prostate cancer; prostate specific antigen; digital rectal examination; radical retropubic prostatectomy; outcome

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