PROSTAT KANSERİNDE AKTİF İZLEM KARARI; BİYOPSİ GLEASON SKORU NE KADAR GÜVENLİ?
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Dosyalar
Tarih
2017
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Prostat spesifik antijenin tanımlanmasından sonra insidental prostat kanseri oranı yükselmiş ve hastalar gereksiz tedavilere maruz kalabilmişlerdir. İnsidental prostat kanseri olan hastalarda herhangi bir tedavi uygulanmadan yakın izlem kılavuzlara girmiş ve hastalara uygulanmaya başlamıştır. Ancak transrektal ultrasonografi eşliğinde biyopsi patolojilerindeki veriler ile radikal prostatektomi spesimen patolojilerindeki verilerin uyumsuzluğu, küratif tedavi ihtiyacı olabilecek hastaları riske atmaktadır. Bu çalışmada; radikal prostatektomi spesimenlerindeki Gleason skorları ile TRUS-bx Gleason skorlarının karşılaştırılması amaçlanmıştır. Materyal – Metot: Mart 2011 ile Haziran 2016 tarihleri arasında, kliniğimizde radikal prostatektomi cerrahisi geçirmiş hastaların verileri retrospektif olarak değerlendirildi. Hastaların transrektal ultrasonografi eşliğinde biyopsi öncesi PSA değerleri, biyopsi kor sayıları, kanser pozitif biyopsi kor sayıları, biyopsideki kanser yüzdeleri ve Gleason skorları tespit edilerek, radikal prostatektomi sonrası Gleason skorları, doku kanser oranları, cerrahi sınırlar ve patolojik evre ile karşılaştırıldı. Bulgular: Toplam 44 hastanın verileri değerlendirildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru <7 olan hastaların 11’inde(%44), prostat spesimen patolojisi Gleason skoru da <7 olarak tespit edildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru 7 olan hastaların 8’inde (%61,5) prostat spesimen patoloji Gleason skoru 7 olarak tespit edildi. Trus-bx patolojisinde Gleason skoru >7 olan hastaların 1’inde (%16,6) prostat spesimen Gleason skoru >7 olarak tespit edildi Sonuç: Transrektal ultrasonografi eşliğinde biyopsi patolojilerinde bildirilen Gleason skorları ile radikal prostatektomi Gleason skorları arasında fark olabilmekte, bu fark özellikle biyopsi Gleason skoru <7 olan hastalarda daha belirginleşebilmektedir. Aktif izlemin hedefi olan bu hasta grubunda, patologların bildirdiği Gleason skorlarının güvenilirliği tartışmalı olup, diğer değişkenler (kor-tümör oranı, tümör kor sayısı, PSA) dikkate alınarak karar verilmesi gerekmektedir.
Aim: With the invention of prostate specific antigen, incidental prostate cancer rates increased significantly and the patients had to be exposed to unnecessary treatments. For those patients with incidental prostate cancer, active surveillance was introduced in the guidelines and has been applied to the patients. But, the pathological mismatch between the transrectal ultrasonography guided biopsy and the radical prostatectomy specimens may risk the patients who need curative treatment. In this study, we aimed to compare the Gleason scores between radical prostatectomy specimens and transrectal ultrasonography guided biopsy. Material-Methods: The data of the patients, who had radical prostatectomy in our clinic between March 2011 and June 2016, had been retrospectively evaluated. The PSA value before transrectal ultrasonography guided biopsy, biopsy core numbers, cancer positive biopsy core numbers, cancer percentage and Gleason scores at biopsy have been noted, and compared with the Gleason score after radical prostatectomy, tissue cancer ratio in prostatectomy specimen, surgical margins and pathologic stage. Results: The data of 44 patients were evaluated. The Gleason score was <7 at 11 (44%) patients in both transrectal ultrasonography guided biopsy and radical prostatectomy. The Gleason score was 7 at 8 (61,5%) patients in both transrectal ultrasonography guided biopsy and radical prostatectomy and the Gleason score was >7 at 1 (16,6%) patient in both transrectal ultrasonography guided biopsy and radical prostatectomy Conclusion: There are differences between transrectal ultrasonography guided biopsy Gleason scores and the radical prostatectomy Gleason scores. This differences especially are obvious in patients with Gleason score <7. The reliability of gleason scores reported by the pathologists might be questionable so, in order to decide active surveillance for patients, other variables (core-tumor ratio, tumor core number, PSA) must also be considered.
Aim: With the invention of prostate specific antigen, incidental prostate cancer rates increased significantly and the patients had to be exposed to unnecessary treatments. For those patients with incidental prostate cancer, active surveillance was introduced in the guidelines and has been applied to the patients. But, the pathological mismatch between the transrectal ultrasonography guided biopsy and the radical prostatectomy specimens may risk the patients who need curative treatment. In this study, we aimed to compare the Gleason scores between radical prostatectomy specimens and transrectal ultrasonography guided biopsy. Material-Methods: The data of the patients, who had radical prostatectomy in our clinic between March 2011 and June 2016, had been retrospectively evaluated. The PSA value before transrectal ultrasonography guided biopsy, biopsy core numbers, cancer positive biopsy core numbers, cancer percentage and Gleason scores at biopsy have been noted, and compared with the Gleason score after radical prostatectomy, tissue cancer ratio in prostatectomy specimen, surgical margins and pathologic stage. Results: The data of 44 patients were evaluated. The Gleason score was <7 at 11 (44%) patients in both transrectal ultrasonography guided biopsy and radical prostatectomy. The Gleason score was 7 at 8 (61,5%) patients in both transrectal ultrasonography guided biopsy and radical prostatectomy and the Gleason score was >7 at 1 (16,6%) patient in both transrectal ultrasonography guided biopsy and radical prostatectomy Conclusion: There are differences between transrectal ultrasonography guided biopsy Gleason scores and the radical prostatectomy Gleason scores. This differences especially are obvious in patients with Gleason score <7. The reliability of gleason scores reported by the pathologists might be questionable so, in order to decide active surveillance for patients, other variables (core-tumor ratio, tumor core number, PSA) must also be considered.
Açıklama
Anahtar Kelimeler
Prostat kanseri, transrektal ultrasonografi, biyopsi, gleason, aktif izlem, Prostate cancer, transrectal ultrasonography, biopsy, gleason, active follow-up
Kaynak
Namık Kemal Tıp Dergisi (International Journal of Basic and Clinical Medicine)
WoS Q Değeri
Scopus Q Değeri
Cilt
5
Sayı
2
