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2011, Número 2

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Acta Med 2011; 9 (2)


Prostatectomía radical retropúbica. Experiencia de 15 años en una institución privada

Zonana FE, Sedano LA, Ramírez PEA, Zárate OA, García SM, Athié GJM

Idioma: Español
Referencias bibliográficas: 38
Paginas: 69-82
Archivo PDF: 456.54 Kb.


RESUMEN

El presente estudio incluye 105 pacientes con cáncer de la próstata clínicamente localizado sometidos a prostatectomía radical retropúbica neuroconservadora en un hospital privado: 46 pacientes (43.8%) tuvieron cáncer localmente avanzado, 31 pT3a y 8 pT3b. De los 97 pacientes con APE entre 4.1 y 17.5 ng/mL, 42 pacientes (43%) tuvieron pT3. Otros factores de riesgo fueron la palpación de una lesión indurada en el examen digital rectal, la presencia de una área hipoecoica en la zona periférica del ultrasonido transrectal de la próstata, así como aquellos pacientes que en la biopsia de la próstata tuvieron 2 o más fragmentos positivos, ya que en alto porcentaje de éstos presentaron enfermedad localmente avanzada en la pieza quirúrgica. El tratamiento empleado en los pacientes con pT3a y pT3b fue terapia combinada adyuvante, es decir terapia hormonal entre 18 y 24 meses y radioterapia con acelerador lineal con dosis de 64 a 68 Gy. Aunque el número de casos es pequeño y el tiempo de seguimiento es variable se puede considerar que dicho tratamiento tuvo influencia en la sobrevida libre de falla bioquímica y la sobrevida global.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murria T et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71.

  2. Hill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352: 1977.

  3. Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM et al. The contemporary management of prostate cancer in the United States: Lessons from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national disease registry. J Urol 2004; 171: 1393.

  4. Klein EA, Bianco FJ, Serio AM, Eastham JA, Kattan MW, Pontes JE et al. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol 2008; 179: 2212.

  5. Swindle P, Eastham JA, Ohori M, Kattan MW, Wheler T, Maru N et al. Do margins mater? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 2008; 179: 147.

  6. Zonana FE, Zarate OA y cols. Prostatectomia Radical. Experiencia a 5 años. XXIV Congreso de la Confederación Americana. Cancún, México. Noviembre 1998. Resumen 240.

  7. Myers RP. Detrusor apron, associated vascular plexos, and avascular plane: relevance to radical retropubic prostatectomy-anatomic and surgical commentary. Urology 2002; 59: 472-479.

  8. Epstein JI, Pizov G, Walsh PC. Correlation of pathologic findings with progression following radical retropubic prostatectomy. Cancer 1993; 71: 3582.

  9. Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT. Pronostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 1995; 154: 1818-1824.

  10. Stamey TA, Villers AA, McNeal JE, Link PC, Frehiha FS. Positive surgical margins at radical prostatectomy: importance of the apical dissection. J Urol 1990; 113: 1166.

  11. Ackerman DA, Barry JM, Wicklund RA, Olson N, Lowe BA. Analysis of risk factor associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. J Urol 1993; 1M: 1845.

  12. Chang L, Darson MF, Bergstralh EJ et al. Correlation margin status and extraprostatic extension with progression of prostate carcinoma. Cancer 1999; 86: 1775-1782.

  13. Sheldom CA, Williams RD, Fraley EE. Incidental carcinoma of the prostate; a review of the literature and critical reappraisal of classification. J Urol 1980; 124: 626.

  14. Prout GR Jr. Diagnosis and staging of the prostatic carcinoma. Cancer 1973; 32: 1096.

  15. Schmidt JD, Mettlin CJ, Natarajan N, Peace BB, Beart RW, Winchester DP, Murphy GP. Trends in patterns of care for prostate cancer, 1974-1983: results of surveys by the American College of Surgeons. J Urol 1986; 136: 416.

  16. Scardino PT. Early detection of prostate cancer. Urol Clin N Am 1989; 16: 635.

  17. Greene DR, Egawa S, Neerhut G, Flanagan W, Wheeler TM, Scardino PT. The distribution of residual cancer in radical prostatectomy specimens in stage. A Prostate cancer. J Urol 1991; 145: 324-329.

  18. Schulte RT, Wood DP, Diagnault S, Shah RB, Wei JT. Utility of extended pattern prostate biopsies for tumour localization. Cancer 2008; 113: 1559-1565.

  19. Barber T, Pansare V, Nikolavsky D, Pontes JE et al. Pathologic characteristic of contralateral prostate cancer among patients with a single positive core. J Urol 2006; 175: Abstracts 1573.

  20. Scales CD Jr., Durham NC, Christopher LA et al. Can unilateral prostate cancer be reliably predicted based upon biopsy features? J Urol 2006; 175: Abstracts 1162.

  21. Ornstein DK, Colberg JW, Virgo KS et al. Evaluation and management of men whose radical prostatectomies failed: results of an international survey. Urology 1998; 52: 1047-1054.

  22. Grossfeld GD, Stier DM, Flanders SC et al. Use of second treatment following definitive local therapy for prostate cancer. J Urol 1998; 160: 1398-1404.

  23. Cox JD, Gallagher MJ, Hammond EH, Kaplan RS. Radiology and Oncology Consensus Panel. Consensus statements on radiation therapy of prostate cancer: guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate specific antigen levels after radical prostatectomy. J Clin Oncol 1999; 17: 1155-1163.

  24. Cadeddu JA, Partin AW, DeWeese TL et al. Long-term results of radiation therapy for prostate cancer recurrent following radical prostatectomy. J Urol 1998; 159: 173-178.

  25. Bolla M, Van Popell H, Collete L et al. Postoperative radiotherapy after radical prostatectomy: a randomized controlled trial (EORTC trial 22911). Lancet 2005; 366: 572-578.

  26. Wiegel T, Bohke D, Willich N. Phase III results of adjuvant radiotherapy versus “wait and see” in patients with pT3 prostate cancer following radical prostatectomy (ARO 92-02/AUO AP 0995). J Clin Oncol 2005; 23: 165 (abstract no. 3815).

  27. Thompson IM, Tangen CM, Paradelo J et al. Adjuvant radiotherapy for pathologically advanced prostate cancer, a randomized clinical trials. JAMA 2006; 296: 2329-2335.

  28. Thompson IM, Tangen CM, Paradelo JM et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: Long-Term followup of a randomized clinical trial. J Urol 2009; 181: 956-962.

  29. Zietman AL, Prince EA, Nakfoor BM, Park JJ. Androgen deprivation and radiation therapy: sequencing studies using the Shionogi in vivo tumor system. Int J Radiation Oncology Biol Phys 1997; 38: 1067-1070.

  30. Joon DL, Hasegawa M, Sikes C et al. Supraadditive apoptotic response of R3327-G rat prostate tumors to androgen ablation and radiation. Int J Radiat Oncol Biol Phys 1997; 38: 1071-1077.

  31. Pilepich MV, Sause WT, Shipley WU et al. Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 1995; 45: 616-623.

  32. Pilepich MV, Winter K, John MJ et al. Phase III Radiation Therapy Oncology Group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001; 50: 1243-1252.

  33. Roach M, Bae K, Speight J, Wolkov HB, Rubin P, Lee RJ, Lawton C, Valicenti R, Grignon D, Pilepich MV. Short-term neoadyuvant androgen deprivation therapy and external- beam radiotherapy for locally advanced prostate cancer: Long-term results of RTOG 8610. J Clin Oncol 2007; 10: 1200.

  34. Pilepich MV, Winter K, Lawton CA et al. Androgen Supression adjuvant to definitive radiotherapy in prostate carcinoma-long term results of Phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 2005; 61: 1285-1290.

  35. Hanks GE, Pajak TF, Porter A et al. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: The Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol 2003; 21: 3972-3978.

  36. Bolla M, Collete L, Blank L et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomized trial. Lancet 2002; 360: 103-108.

  37. D´Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW, 6 month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004; 292: 821-827.

  38. Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, di´SantAgnese PA, Trump D, on behalf of the Eastern Cooperative Oncology Group study EST 3886. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 2006; 7(6): 472-479.




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