Analysis of the clinical efficacy and safety of laparoscopic radical prostatectomy in prostate cancer patients aged 80 years or older / 现代泌尿外科杂志

【Objective】 To investigate the clinical efficacy and safety of laparoscopic radical prostatectomy in elderly prostate cancer patients aged ≥80 years in good health. 【Methods】 A total of 18 octogenarian patients who underwent laparoscopic radical prostatectomy during Aug.2016 and Mar.2020 at our hospital were selected for retrospective analysis. 【Results】 The patients were 80 to 86 years old. The preoperative serum PSA was 5.25-101.00 ng/mL. There were 2 cases in stage cT1N0M0,12 in stagec T2N0M0 and 4 in stage cT3N0M. The Gleason score was ≤6 in 4 cases,=7 in 9 cases,and ≥8 in 5 cases. During the follow-up of 22 to 65 months,the rates of urinary incontinence at 1 month,3 months,6 months,and 1 year were 50.00% (9/18),33.33% (6/18),16.67% (3/18) and 5.56 %(1/18),respectively. The postoperative urinary control recovery time was 1 to 220 days. Positive incision margin developed in 3 cases and biochemical recurrence occurred in 3 cases. The IPSS score at 3, 6 months and 1 year after surgery were lower than these before surgery (P<0.05). The overall health score of the FACD-P scale at 6 months after surgery was higher than that before surgery (P<0.05). 【Conclusion】 For well selected octogenarian prostate cancer patients in good condition,laparoscopic radical prostatectomy is a feasible,safe and effective treatment option,but long-term follow-up and prospective clinical studies with large sample size are still needed to confirm its efficacy.

Clinical application of free/total PSA ratio in the diagnosis of prostate cancer in men over 50 years of age with total PSA levels of 2.0-25.0 ng ml-1 in Western China / 亚洲男科学杂志(英文版)

The goal of this study was to investigate the clinical application of free/total prostate-specific antigen (F/T PSA) ratio, considering the new broad serum total PSA (T-PSA) "gray zone" of 2.0-25.0 ng ml-1 in differential diagnosis of prostate cancer (PCa) and benign prostate diseases (BPD) in men over 50 years in Western China. A total of 1655 patients were included, 528 with PCa and 1127 with BPD. Serum T-PSA, free PSA (F-PSA), and F/T PSA ratio were analyzed. Receiver operating characteristic curves were used to assess the efficiency of PSA and F/T PSA ratio. There were 47.4% of cancer patients with T-PSA of 2.0-25.0 ng ml-1. When T-PSA was 2.0-4.0 ng ml-1, 4.0-10.0 ng ml-1, and 10.0-25.0 ng ml-1, the area under the curve (AUC) of F/T PSA ratio was 0.749, 0.769, and 0.761, respectively. The best AUC of F/T PSA ratio was 0.811 when T-PSA was 2.0-25.0 ng ml-1, with a specificity of 0.732, a sensitivity of 0.788, and an optimal cutoff value of 15.5%. The AUC of F/T PSA ratio in different age groups (50-59 years, 60-69 years, 70-79 years, and ≥80 years) was 0.767, 0.806, 0.815, and 0.833, respectively, and the best sensitivity (0.857) and specificity (0.802) were observed in patients over 80 years. The T-PSA trend was in accordance with the Gleason score, tumor node metastasis (TNM) stage, and American Joint Committee on Cancer prognosis group. Therefore, the F/T PSA ratio can facilitate the differential diagnosis of PCa and BPD in the broad T-PSA "gray zone". Serum T-PSA can be a Gleason score and prognostic indicator.

Niveles séricos del antígeno prostático específico (PSA) dentro de la campaña de prevención del cáncer de próstata / Serum levels of the prostate-specific antigen (PSA) in the prostate cancer prevention campaign

La determinación del antígeno prostático específico (PSA) forma parte del diagnóstico del cáncer de próstata. Como en condiciones patológicas sus niveles aumentan, es considerado marcador tumoral útil de diagnóstico de cáncer de próstata en forma precoz. Determinamos los niveles séricos de PSA, dentro de la campaña “Semana de la Próstata” organizado por la Cátedra de Urología del Hospital de Clínicas en Octubre 2007. De los 89 pacientes, el 86,5% presentó niveles de PSA entre 0 y 4ng/ml, 10,1% entre 4 y 10 ng/ml y el 3,4% entre 10 y 40 ng/ml respectivamente. Se realizó una distribución por edad y se determinaron las medias de los valores de PSA en los mismos. El 12,4% del grupo E1 (41 a 50 años) con 0,5ng/ml de PSA, el 52,8% del grupo E2 (51 a 60 años) con 7,4ng/ml de PSA, el 28,1% del grupo E3 (61 a 70 años) con 5,2ng/ml de PSA y el 6,7% del grupo E4 (71 a 80 años) con 1,5 ng/ml de PSA. Hallándose valores más elevados de PSA en el grupo E2 y E3, no así en el grupo E4. En relación al tacto rectal (TR) y los valores del PSA, el 31,5%(28) presentaron TR normal con un valor medio de PSA de 3,4. Mientras que el 65,1% (58) presentaban TR patológico con valores medios de PSA de 7,17 en 55 pacientes y sólo 3 pacientes con TR patológico presentaron niveles de PSA por debajo de 2,5 ng/ml. El TR resultó ser la variable con mayor poder de discriminación, con respecto al resultado de PSA en estos pacientes.

The determination of prostate-specific antigen (PSA) is part of the diagnosis of prostate cancer.It is considered an useful tumor marker for early diagnosis of porostate cancer because in pathological conditions its levels increase.Serum levels of PSA were determined within the campaign "Prostate Week" organized by the Department of Urology of the Hospital de Clínicas in October 2007.;Of the 89 patients, 86.5% had PSA levels between 0 and 4 ng/ml, 10.1% between 4 and 10 ng/ml and 3.4% between 10 and 40 ng/ml respectively. An age distribution was made and the mean of PSA values were determined in each group. Twelve point four percent of group E1 (41 to 50 years) had 0.5 ng/ml of PSA, 52.8% of group E2 (51 to 60 years) 7.4 ng/ml PSA, 28.1% of E3 group (61 to 70 years) 5.2 ng/ ml of PSA and 6.7% of the E4 group (71 to 80 years) had 1.5 ng/ml of PSA.The highest values of PSA were found in E2 and E3 groups, but not in the E4 group. In relation to digital rectal examination (DRE) and PSA values, 31.5% (28) showed normal DRE with a mean value of PSA of 3.4 while 65.1% (58) had pathological DRE with mean values of PSA of 7.17 in 55 patients and only 3 patients had pathological TR with PSA levels below 2.5 ng/ml. The DRE was the variable with the greatest ability to discriminate in relation to the results of PSA in these patients.

A Pilot Study On Percent Free Prostate Specific Antigen As An Additional Tool In Prostate Cancer Screening

A cross sectional pilot study was carried out to look into the usefulness of percent free prostate specific antigen (fPSA) in the diagnosis of prostatic cancer in HUSM patients. All patients who attended surgical clinic and admitted to surgical wards with signs and symptoms of prostate problems during the study period were taken as the study subjects. Total prostate specific antigen (tPSA) was estimated by immunoassay technique and those values of 4 ng/mL or more were proceeded for estimation of fPSA. Using the cut-off value of less than 25% fPSA for diagnosing patients with prostate cancer, our study showed that majority of the prostate cancer patients have a ratio of fPSA:tPSA more than 25% and a significantly higher level of total prostate specific antigen (P<0.005) when compared with patients with benign prostatic hyperplasia (BPH). Unexpectedly, the fPSA values were high in patients diagnosed as prostate cancer compared to BPH. Ratio of percent fPSA to tPSA was found not to be sensitive and specific, in diagnosing prostate cancer at the cut-off value of 25%. In conclusion, total PSA is a more useful biochemical test for diagnosing prostate cancer in our patients.