Onkologische und funktionelle Ergebnisse nach radikaler Prostatektomie bei Patienten mit High-Risk-Prostatakarzinom

Zusammenfassung: Für die vorliegende Arbeit wurden die klinischen Verläufe von 489 Patienten ausgewertet, die zwischen 2004 und 2014 im Klinikum Fulda operativ mit radikaler Prostatektomie therapiert wurden. Das Follow-up betrug im Median 48,8 (Range: 1,03–128,23) Monate und im Mittel 53,42 (Standa...

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Bibliographic Details
Main Author: Ba-khmais, Salem Mohammed Gumaan
Contributors: Kälble, Timan (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2021
Online Access:PDF Full Text
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The observation period was ten years with a median of 48.8 months (range: 1.03–128.23) and a mean of 53.42 months (standard deviation: ± 30.54). 113 (23.55%) patients had a PSA greater than 20, 133 (27.2%) patients had positive lymph nodes, 145 (29.8%) had a pathologic Gleason score 8-10, and 123 (25.3%) patients had a positive marginal incision. The progression-free, metastasis-free, carcinoma-specific and overall survival were each shown with the above-mentioned criteria in the Kaplan-Meier curve and checked with regard to its significance. A PSA greater than 20, a Gleason score of 8-10, and positive lymph nodes have a negative impact on the oncological outcome and patients have a poorer prognosis. A significant difference in subjects with a positive (R1) and negative (R0) resection margin as well as GS (7b) and GS (8-10) could not be demonstrated in this work. Regarding continence as a functional outcome, the majority of patients (79.73%) regained continence within two years after surgery. Thus, the time interval from the operation proves to be an important factor in restoring continence. After the second postoperative year, the majority of patients (82.4%) are very satisfied or mostly satisfied with their quality of life with regard to incontinence. Radical prostatectomy is a useful and potent treatment option in patients with high-risk criteria with good oncological and functional results. Our results are compatible with other large studies, so that the quality of radical prostatectomy in the Department of Urology can be classified as very good. For the present work, the clinical courses of 489 patients who underwent radical prostatectomy surgery atthe Fulda Clinic between 2004 and 2014 were evaluated. The follow-up was a median of 48.8 months (range: 1.03-128.23) and a mean of 53.42 months (standard deviation: ± 30.54). All patients had high-risk prostate cancer with the following criteria: PSA > 20, Gleason score > 7 and/or histopathological stage ≥ pT3a. The aim of this work was to compare the oncological and functional results after radical prostatectomy in patients with the diagnosis 'high-risk prostate carcinoma' as a quality control with other similar works. With regard to the oncological results, the PSA-progression-free, metastasis-free, carcinomaspecific and overall survival was determined for the entire course as well as in relation to the resection margin, lymph node status and number, Gleason score and preoperative PSA value. A significant difference showed the PSA-progression-free, metastasis-free, cancer-specific and overall survival in positive and negative lymph nodes n (pN1 in ten years of follow-up: 59.4%, 84.9%, 89.47%, 84.2%, pN0 at ten years of follow-up: 76.34%, 96.6%, 97.47%, 94.9%, pN1 at five years of follow-up: 72.2%, 88.7%, 92.5 %, 89.5%, pN0 at five years follow-up: 88.7%, 97.5%, 98.3%, 96.6%), GS 6-7a and 8-10 (GS 6-7a in ten years follow-up: 80.7%, 98%, 98%, 95.1%, GS 8-10 at ten years follow-up: 56.6%, 87.6%, 91.7%, 88, 3%, GS 6-7a at five years follow-up: 91%, 98% 98.4%, 97.1%, GS 8-10 at five years follow-up: 72.4%, 89.7%, 93.1%, 91.03%), preoperative PSA > 20 and ≤ 20 (PSA > 20 at ten years follow-up: 55.7%, 87.61%, 90.3%, 83.2%, PSA ≤ 20 at ten years of follow-up: 76.44%, 95.4%, 96.7%, 94.5%, PSA > 20 at five years of follow-up: 75.2%, 92%, 92.9%, 88.5%, PSA ≤ 20 at five years follow-up: 82.9%, 96.2%, 97.8%, 96.4%). Even when comparing 1-2 to > 2 affected lymph nodes, there were significant differences in terms of PSA-progression-free, metastasis-free, and overall survival (1-2 LK in ten years of follow-up: 63%, 90.2%, 89%, > 2 LK in 10 years follow-up: 28%, 76.1%, 76%, 1-2 LK in 5 years follow-up: 82.9%, 92.7%, 97.7% > 2 LK in 5 years of follow-up: 52.2%, 78.3%, 84.8%), while carcinoma-specific survivalshowed no significant difference (ten years of follow-up at 1-2 LN: 90.2% and >2 LK: 87%, five years follow-up at 1-2 LK: 92.7 and >2 LK: 91.3%). Likewise, no significant differences between positive and negative resection margins, as well as GS 7b and 8-10 could be detected (the PSA-progression-free, cancer-specific, metastasis-free and overall survival in R1 at ten years of follow-up: 68%, 94.3%, 91.9%, 89.4% and at five years of follow-up: 85.2%, 95.9%, 92.7%, 93.5% and at R0 at ten years of follow-up: 73.1%, 95.6%, 94.2%, 92.9% and at five years of follow-up: 81.1%, 97%, 96.2%, 95.1% PSA-progression-free, cancer-specific, metastasis-free and overall survival in GS 7b at ten years of follow-up: 71.1%, 92, 8%, 90.7%, 89.7% and at five years follow-up: 84.5%, 95.9%, 94.8%, 93.8%). With regard to the functional results, postoperative incontinence and erectile dysfunction were evaluated. Since not enough data was available for erectile dysfunction and the patients did not undergo nerve-sparing surgery, the evaluation was not discussed. Incontinence and patient satisfaction improved significantly over the two-year observation period. (See Table 16 and 17) Both the oncological and functional results are consistent with other large studies. On the one hand, this proves that radical prostatectomy in patients diagnosed with high-risk prostate carcinoma is a useful therapeutic procedure with good oncological and functional results. On the other hand, the results show that the quality of radical prostatectomy in high-risk prostate cancer is comparable to other large studies.