| Abstrakt: |
Introduction. Prostate cancer may express great variety in clinical behavior, from an indolent evolution to lethal disease. According to preoperative d'Amico criteria it is appreciated that patients with localized prostate cancer, PSA > 20 ng/ml, Gleason score of 8 to 10 are classified at high risk for recurrence of symptomatic or asymptomatic metastatic disease. The Scandinavian Prostate Cancer Group 4 (SPCG-4) and Prostate Intervention Versus Observation Trial (PIVOT) trials generated new coordinates in the means of the right moment and treatment option in prostate cancer. Objective. The aim of this study was to determine the number of patients restaged in the means of risk stratification after pathologic results from the radical prostatectomy specimen. Materials and methods. 218 patients with prostate cancer were enrolled in a prospective study between June 2011 and January 2014, after obtaining the informed consent. All cases underwent open retropubic radical prostatectomy in our Center. Results. Of the 29 pts staged preoperatively as cT1c, 21 were staged as pT2 postoperatively, the rest being staged as pT3. From the preoperative group staged cT2, after surgery and pathology, one case is staged pT1, 40 pts pT3, one case pT4 and only 48 pts staged pT2, the same as before surgery. For cT3 stage, 61 pts were actually pT3, representing 55,5% of the cT3 group, and 28% of the total number of pts in the study, as 36 pts were reassigned to other risk groups. Of the two cT4 cases, one was actually pT4 and one pT3. Of the preoperative 2-6 Gleason group, 34,6% were reassigned to the intermediate risk group, and 4,8% were restaged as high risk. Of the initial intermediate risk group, 43 were actually intermediate risk, 17 pts were reassigned to low risk Gleason 2-6 group, and the remaining 11 were Gleason 8 and 9. Preoperatively high risk pts were restaged as follows: 17,3% reassigned to low risk group, 21,7% intermediate risk,the remaining 61 % maintaining in the high risk group. Conclusions. For cT1c, 27,6% of the cases areoverstaged after pathology report, as for cT2 the proportion being even higher, of 45,5%, which explains the high risk of progression without surgical treatment for this stage. According to statistical data, cT3 stage isthen placed in an inferior risk group in 34% of cases. Regarding the number of initially overstaged patients (based upon cT), 16% of the study group are overstaged preoperatively, of which 33 pts fall in the cT3 stage, this being probably the result of insufficient information from the preoperative panel consisting of transrectal ultrasound, serum PSA, digital rectal examination and Gleason score from the biopsy specimens. [ABSTRACT FROM AUTHOR] |
