Klinische Charakteristika des lokal begrenzten Prostatakarzinoms

Carcinoma of the prostate is the most common malignancy diagnosed in German men. Since the prostate spezific antigen (PSA) is routinely used as a tumor marker a stage-shift from advanced tumors to localized tumors has been noted. The aim of this study was to evaluate demographic, clinical, histopathology and quality of life data of 686 patients who underwent a radical retropubic prostatectomy between 1989 and 1999 at the department of urology in Marburg. The initial hypothesis that patients from rural areas present with a higher stage prostate cancer compared to city dwellers could be disproved. In both patient groups the number of advanced tumors reduced in the same extense in a period of 5 years. We could show that the screening programs and the urologic health care in both areas are comparable. Patients younger than 55 years were likely to have a higher probability of recurrence than patients older than 65 years. The following parameters including PSA, T-stage and grading were not significantly different in both groups. We conclude from these data that patients with prostate cancer at an avarage age of younger than 55 years do not suffering from a more aggressiv tumor. Although a positiv nodal status had a significant impact on PSA, T-stage and grading, the incidence of recurrence and the long term survival did not differ in this group compared to the group with negativ lymph node status. An other issue of this study was to evaluate whether the radical prostatectomy is justified in patients with a PSA higher than 20 ng/ml. Analysis of the data revealed that PSA value of more than 20 ng/ml correlates with a higher incidence of advanced carcinomas, positiv lymphnodes and recurrences, but the long term survival of these patients was 82%. Therefore we concluded that radical prostatecotmy should not be denied to these patients. The majority of the patients reported good to excellent qualitiy of life with respect to incontinence and impotence using a validated and home made questionnaire. 93.5% of the patients would undergo surgery again. In conclusion this analysis of 686 patients verified that the radical prostatectomy is a valid approach for prostate cancer with excellent tumor controll and quality of life.