Cancer - Prostate(구연) (E-135)

근치적전립선절제술 후 pT3와 외과적변연양성의 예측에 있어서 Prostate MRI, 전립선 조직검사 결과, 술전 DRE 병용의 효과
아주대학교 의과대학 비뇨의학과교실
유희재, 박성곤, 심강희, 추설호, 김선일, 최종보, 안현수, 김세중
Background and Objectives
To evaluate the usefulness of combining prostate MRI, prostate biopsy data with preoperative digital rectal examination (DRE) in planning surgical extent of radical prostatectomy (RP) and predicting pT3 disease and surgical margin (SM) status.
Materials and Methods
163 consecutive patients who underwent RP by a single surgeon and who had staging prostate MRI, DRE record and the extent of prostatic fascial dissection (FD) (i.e. intra-, inter- and extra-) documented were enrolled. DRE was performed by the surgeon at the operative table after the general anesthesia. The extent of FD on each side of the prostate was decided by combining information from MRI, DRE and prostate biopsy (i.e. Gleason score, number of positive cores, tumor volume %). Retrospectively, two other urologic oncology surgeons scored the appropriateness of the extent of FD on a Likert scale of 5 to 1, meaning “very appropriate”, “appropriate”, “somewhat appropriate”, “inappropriate” and “very inappropriate” in decreasing order. Receiver operating characteristic curves was used to assess performance of DRE, MRI and the combination of both (DRE+MRI) in predicting pT3 disease and area under the curve (AUC) was calculated. McNemar test was used to compare sensitivity and specificity between DRE, MRI and DRE+MRI in detecting ≥pT3 and ≤pT2 disease.
184, 91 and 51 sides of prostate (total of 326) underwent intra-, inter- and extra-FD, respectively. Of 184 intra-FD, 163(89%) scored ≥3 for appropriateness of FD, and 160(87%) were ≤pT2. Among those who scored ≥3, 148(91%) were ≤pT2. SM+ rate in all intra-FD and in intra-FD and score ≥3 was 43% and 40%, respectively. Of 91 inter-FD, 76(84%) scored ≥3, and 58(64%) were ≤pT2. Among those who scored ≥3, 57(75%) were ≤pT2. SM+ rate in all inter-FD and in inter-FD and score ≥3 was 62% and 55%, respectively. Of 51 extra-FD, 51(100%) scored ≥3, and 37(73%) were ≥pT3. SM+ rate was 75% for extra-FD. AUC for DRE, MRI and DRE+MRI were 0.629, 0.692 and 0.733, respectively. The sensitivity and specificity of DRE+MRI in predicting ≥pT3 was higher than DRE and MRI alone (p<0.001, p=0.001, p=0.001, p=0.008).
DRE enhanced the efficacy of MRI in predicting pT3 in patients undergoing RP. Whether it could serve as a reliable guide in deciding the mode of fascial dissection remains to be seen.
keywords : Preoperative DRE, Radical prostatectomy, pT3