Is Pathological Grade Increase Predictable Prior to Robot-Assisted Laparoscopic Radical Prostatectomy?

INTRODUCTION: Prostate Cancer(PCa) is the most common cancer disease among men. The pathologic grade of tumor has an important place in patient’s treatment plan. In our study, we aimed to predict the increase in the tumor grade of prostatectomy specimens than biopsy degree in the patients who underwent Robot-Assisted Laparoscopic Radical Prostatectomy(RALRP) due to PCa diagnosis.
METHODS: The data of 109 patients who were diagnosed with PCa and underwent RALRP between August 2019 and May 2020 were analyzed retrospectively in our clinic. Surgical operations were carried out by Da Vinci Xi surgical robot system (Intuitive Surgical, Sunnyvale, CA, USA). The patients whose ISUP rating in post RALRP examination increased compared to the prostate biopsy were classified as group-1; patients remained same or decreased were classified as group-2. The patient’s age, prostate-specific antigen(PSA), prostate volume, rectal examination by palpation (DRE) findings, Neutrophil/ Lymphocyte ratio (NLR), Platelet/ Lymphocyte ratio(PLR) and AST/ALT (De Ritis) values were compared in these two groups.
RESULTS: The average age of patients included in this study was 64.32 ± 6.20 (46-77) years, the PSA value was 9,46±10,84 (0,5-86) ng/mL and prostate volume was 49.19 ± 25.72 ( 18-145) mL. Increase in tumor grade after RYLRP was detected in 33 (%36,7) patients, while the grade remained in 48 (%53,3) patients, 9 (%10) patients had a decrease. Although, age, PSA, pathological result ratio in DRE, NLR and De Ritis ratio were found higher in group-1 than group-2, this highness was not statistically significant (p>0,05). PLR was significantly higher in group 1 than group 2 (p=0,026).
DISCUSSION AND CONCLUSION: In our study, although only the increase in PLR was found to be statistically significant, all other parameters except for prostate volume were found to be high in the group with an increase in tumor grade.

Robot Yardýmlý Laparoskopik Radikal Prostatektomi öncesinde Patolojik Derece Artýþý Öngörülebilir mi?

GÝRÝÞ ve AMAÇ: Prostat Kanseri (PK) erkeklerde en sýk görülen kanser türüdür. Hastalarýn tedavi planýnda tümörün patolojik derecesinin önemli yeri bulunmaktadýr. Çalýþmamýzda PK tanýsý nedeniyle Robot Yardýmlý Laparoskopik Radikal Prostatektomi (RYLRP) yapýlan hastalarda prostatektomi spesmenindeki tümör dereceleri, biyopsi derecelerinden yüksek çýkanlarda, bu artýþý öngörmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde Aðustos 2019–Mayýs 2020 tarihleri arasýnda PK tanýsý almýþ ve RYLRP yapýlan 109 hastanýn bilgileri retrospektif olarak incelendi. Cerrahi iþlemler Da Vinci Xi robot sistemi (Intuitive Surgical, Sunnyvale, CA, USA) ile gerçekleþtirildi. RYLRP sonrasý incelemedeki ISUP derecesi, prostat biyopsi derecesine göre artmýþ olan hastalar grup-1; ayný kalan ya da azalan hastalar ise grup-2 olarak sýnýflandýrýldý. Bu iki gruptaki hastalarýn yaþ, Prostat Sepsifik Antijen (PSA), prostat hacmi, parmakla rektal muayene (PRM) bulgusu, Nötrofil/ Lenfosit oraný (NLO), Trombosit/Lenfosit oraný (TLO) ve AST/ALT (De Ritis) deðerleri karþýlaþtýrýldý.
BULGULAR: Çalýþmaya dahil edilen hastalarýn ortalama yaþý 64,32±6,20 (46-77) yýl, PSA deðeri 9,46±10,84 (0,5-86) ng/mL ve prostat hacmi 49,19±25,72 (18-145) mL idi. RYLRP sonrasý tümör derecesinde artýþ 33 (%36,7) hastada tespit edildi, 48 (%53,3) hastada derece ayný kalýrken 9 (%10) hastada düþüþ mevcuttu. Yaþ, PSA, prostat hacmi, PRM’de patolojik bulgu oraný, NLO ve De Ritis oraný grup 1’de, grup-2’ye göre yüksek bulunsa da bu yükseklik istatistiksel olarak anlamlý deðildi (p>0,05). TLO ise Grup-1’de, Grup-2’ye göre anlamlý olarak yüksekti (p=0,026).
TARTIÞMA ve SONUÇ: Çalýþmamýzda her ne kadar sadece TLO’daki artýþ istatistiksel açýdan anlamlý olarak bulunsa da prostat hacmi hariç diðer tüm parametreler tümör derecesinde artýþ saptanan grupta yüksek bulunmuþtur.