Prostat Kanserli Hastalarda Tedavi Sonuçlarımızın Değerlendirilmesi

Abstract

We performed a retrospectively analyses of 690 curative prostate cancer (PCa) patients that are treated at the Univercity of Hacettepe between March 1998-May 2012. In patient groups, 108 men were treated as a salvage radiotherapy (RT) after radical prostatectomy and 482 men were treated with definitive RT with or without neoadjuvan or adjuvant androgen deprivation therapy (ADT). The targets were prostate and seminal vesicules with the help of three dimensional conformal RT at definitive group. Salvage RT was applied 50 Gy with priorly pelvis box technic and boost to prostatic bed. We analysed overall survival (OS), PSA relapse free survival (bRFS) and freedom from metastasis (FFM) according to the treatment and D’Amico risk groups, Gleason score (GS), initial PSA, T and N stages, perineural invasion (PNI) at biopsy, percent of positive cores (PPC) and total percentage of carcinoma (TPC). Average follow-up time was 4.7 years. Out of 690 men, there were 136 (%19.7) PSA relapses, 45 (%6.5) distant metastasis,15 (% 2) local relapses and 469 men had never relapsed (%68). OS at 5 and 10 years were % 95 and % 86.5 and bRFS were %73.5 and %56.6 respectively. On univariate analysis initial PSA (P<0.001),GS (P=0.002), lymph node (P<0.001) and seminal vesicule (P=0.009) involvement, PNI and TPC (≥%50) were significant while multivariate analysis showed that PSA and nodal invasion for OS; T, N stage, PSA and GS for bRFS; GS and nodal invasion for FFM were independent prognostic factors. Also ≥ 1 year ADT (1-2 years) didn’t gain an advantage over 9 monthly TAB at GS-8-10 and D’Amico high risk groups. For risk stratification in addition to GS, PSA, T and N stage we can also use PNİ, PPC and TPC. Because of poor outcomes of PNI (+) and ≥%50 TPC patients, we may apply dose escalation and/or ADT.