Clýnýcal And Pathologýcal Characterýstýcs Of pT0 Patýents After Robot Assýsted Laparoscopýc Radýcal Prostatectomy

INTRODUCTION: To determine the pathological and clinical characteristics of these patients with pT0 ratio in the pathology specimen of patients undergoing robot-assisted laparoscopic radical prostatectomy and extended pelvic lymph node dissection.
METHODS: The data of 1950 patients who underwent robot-assisted laparoscopic radical prostatectomy and bilateral dilated pelvic lymph node dissection in a single center between 2009-2019 were analyzed retrospectively. Patients' age, preoperative serum PSA, clinical stage, prostate biopsy results (Gleason grade, biopsy number, total core and positive core number, tumor length and percentage in core), weight of pathological specimen and other pathology data were recorded. Increasing PSA level above 0.2 ng / ml in postoperative follow-up was accepted as biochemical recurrence.
RESULTS: 16 of the 1950 patients who underwent robot-assisted laparoscopic radical prostatectomy were reported as pT0. The mean PSA value was 9.3 ± 1.06 ng / ml (0.25-34.6). Ten patients with pT0 pathology after RYLRP had neoadjuvant hormone therapy (NHT) and 1 patient had a history of TUR-P. Five patients had no history of NHT or TUR-P and were reported as pT0 in RYLRP due to low-risk prostate cancer in biopsy. The average prostate weight was 60.3 ± 30.8 g (26-154). The mean follow-up was 18.64 ± 4.66 (12-80 months). Recurrence of PSA was observed in 1 patient and received radiotherapy.
DISCUSSION AND CONCLUSION: Both open and robotic radical prostatectomy pT0 is rare. In a small group of patients receiving preoperative treatment, follow-up should be done carefully in terms of recurrence and systemic progression.

Robot Yardýmlý Laparoskopik Radikal Prostatektomi Sonrasý pT0 Hastalarýn Klinik Ve Patolojik Karakteristikleri

GÝRÝÞ ve AMAÇ: Robot yardýmlý laparoskopik radikal prostatektomi (RYLRP) ve geniþletilmiþ pelvik lenf nodu diseksiyonu yapýlan hasta serimizde patoloji spesmeninde pT0 hastalarýn oraný ile bu hastalarýn patolojik ve klinik özelliklerini belirlemek.
YÖNTEM ve GEREÇLER: 2009-2019 tarihleri arasýnda tek merkezde RYLRP ve bilateral geniþletilmiþ pelvik lenf nodu dsieksiyonu yapýlan toplam 1950 hastanýn verileri retrospektif olarak incelendi.. RYLRP sonrasý spesmenler patolojik olarak incelendi ve pT0 olanlar kaydedildi. pT0 olan hastalarýn yaþý, preoperatif serum PSA düzeyi, klinik evresi, prostat biyopsi sonuçlarý (Gleason derecesi, biyopsi sayýsý, toplam kor ve pozitif kor sayýsý, tümör uzunluðu ve kordaki yüzdesi), patolojik spesmendeki prostat aðýrlýðý ve diðer patoloji verileri kaydedildi. Postoperatif takiplerde PSA düzeyinin iki kez0.2 ng/ ml üzerine ölçülmesi biyokimyasal rekürrens olarak kabul edildi.
BULGULAR: RYLRP yapýlan 1950 hastanýn 16’ sý pT0 olarak raporlandý. Ortalama PSA deðeri 9.3±1.06 ng/ml (0.25-34.6) idi. RYLRP sonrasý pT0 patolojiye sahip 10 hastanýn neoadjuvan hormon tedavisi (NHT) ve 1 hastanýnda TUR-P öyküsü vardý. 5 hastada NHT veya TUR-P öyküsü yoktu ve biyopside düþük riskli prostat kanseri nedeniyle yapýlan RYLRP’ de pT0 olarak raporlandý. Ortalama prostat aðýrlýðý 60.3 ± 30.8 gr (26-154) idi. Ortalama takip süresi 18.64 ± 4.66 (12-80) ay idi. 1 hastada PSA rekürrrensi gözlendi ve radyoterapi aldý.
TARTIÞMA ve SONUÇ: Hem açýk hem de robotik radikal prostatektomi sonrasý pT0 nadir görülmektedir. Cerrahi öncesi tedavi alan küçük bir hasta grubunda takipler rekürrens ve sistemik progresyon açýsýndan dikkatli bir þekilde yapýlmalýdýr.