1. Kırkbeş hastadan oluşan çalışmamızda ortalama tanı yaşı 64,2(45-87), tanı anında ortalama PSA değeri 160,05(1,04-2021) ng/ml idi. On(% 22,2) hastanın Gleason skoru 6, 16(%35,6) hastanın 7, 10(%22,2) hastanın 8, 6(%13,3) hastanın 9 ve 3(%6,7) hastanın ise 10 idi. Hastaların 12(%26,7)'sinde kemik iliği, 12(%26,7)'sinde bölgesel lenf nodu, 10(%22,2)'unda kemik, 5(%11,1)'inde uzak lenf nodu, 2(%4,4)'sinde akciğer, 2(%4,4 )'sinde mesane, 1(%2,2)'inde periton, 1(%2,2)'inde testis metastazı bulunuyordu.
2. Gleason skoru ≤6 olan hastaların ortalama sağkalımı 50,52 ay, 7 olan hastaların 42,41 ay, ≥8 olan hastaların ise 34,19 ay idi. Bu fark istatistiksel olarak anlamlı saptandı(p=0,033). Uzak organ metastazı olan hastaların ortalama sağkalımı 38,7 ay iken, uzak organ metastazı olmayan hastaların ki 50,85 ay idi ve bu fark istatistiksel olarak anlamlıydı(p=0.05).
3. Hastaların 23(%51,1)'ü sadece bikalutamid, 12(%26,7)'si bikalutamid tedavisi sonrası dosetaksel ve 10(% 22,2)'u bikalutamid tedavisi sonrası abirateron alıyordu. Bikalutamid alan hastaların ortalama sağkalımı 50,52 ay, Abirateron alan hastaların ortalama sağkalımı 34,30 ay ve Dosetaksel alan hastaların ortalama sağkalımı 38,77 ay idi ve bu fark istatistiksel olarak anlamlı değildi(p=0,179).
4. Kırkbeş hastadan 38'inin prostat doku, 42'sinin metastatik doku parafin bloğuna ulaşıldı. Prostat doku parafin bloğuna ulaşılan 38 hastanın 15(%39,5)'inde AR-V7 pozitif tespit edilirken, metastaz doku parafin bloğuna ulaşılan 42 hastanın ise 21(%50)'inde AR-V7varyant pozitif tespit edildi. 3(%8,6) hastanın ise prostat doku parafin bloğunda negatif iken, metastatik doku parafin bloğunda AR-V7 varyantı pozitif saptandı. Bu nedenle prostat dokusunda AR-V7 negatif saptansa dahi varsa hastaların metastatik doku örneğinden de AR-V7 bakılması uygun olabilir.
5. Hastaların tedavi sonrası 3. ve 6. ay kontrol PSA değerlerine bakıldı. Hem prostat doku patoloji bloğuna ulaşılan, hem de metastaz doku parafin bloğuna ulaşılan grupta AR-V7 pozitif hastaların kontrol PSA ortalaması AR-V7 negatif
hastalardan daha yüksekti. Prostat doku parafin bloğuna ulaşılan hastalarda 6. ay kontrol PSA'lar arasındaki bu fark istatistiksel olarak anlamlı idi(p=0,035).
6. Hastalar aldığı tedaviye göre bikalutamid, abirateron, dosetaksel olmak üzere üçe ayrıldı. Prostat doku patoloji bloğuna ulaşılan ve üç tedaviden herhangi birini alan hastaların AR-V7 pozitif hastalarda kontrol PSA değerleri daha yüksekti. Metastaz doku parafin bloğuna ulaşılan grupta ise abirateron alan AR-V7 pozitif hastalarda kontrol PSA değerleri daha yüksekken, bikalutamid ve dosetaksel alan grupta AR-V7 negatif hastalarda daha düşüktü.
7. Prostat doku AR-V7 pozitif hastaların ortalama sağkalımı 40,21 ay iken, AR-V7 negatif hastalarınki 47,62 ay idi. Metastaz doku AR-V7 pozitif hastaların ortalama sağkalımı 38,75 ay iken, AR-V7 negatif hastalarınki 49,08 ay idi. her iki grupta da V7 pozitif hastaların ortalama sağkalımı daha kısaydı. AR-V7’nin sağkalımı tahmin etmede bir belirteç olarak kullanılabileceğini düşünmekteyiz. Ancak daha fazla sayıda hasta ve çalışmaya ihtiyaç vardır.
8. Hastalar AR-V7 durumu ile Gleason skoruna göre ortalama sağkalım açısından karşılaştırıldı. Her iki grupta da Gleason skoru arttıkça yaşam süresi kısalıyordu.
Ancak bu fark V7 negatif hastalarda istatistiksel olarak anlamlı iken, AR-V7 pozitif hastalarda anlamlı değildi. Sonuç olarak AR-AR-V7 negatif hastalarda Gleason skoru sağkalım ile ilişkili iken, AR-V7’nin pozitif olması durumunda bu ilişki saptanmamaktadır.
9. Hastalar aldığı tedavi ile AR-V7 durumuna göre sağkalım açısından karşılaştırıldı. Hem prostat doku hem de metastaz doku parafin bloğuna ulaşılan, abirateron kullanan hastalarda AR-V7 pozitif grupta ortalama genel sağkalım, AR-V7 negatif gruba göre yaklaşık 10 ay daha kısaydı. Dosetaksel alan grupta ise AR-V7 negatif hastaların ortalama genel sağkalımı daha kısaydı. Bu sonuca göre Abirateron tedavisi planlanan hastalarda tedavi öncesi AR-V7 bakılması uygun görünmektedir.
10. Sonuç olarak; primer tümör ve/veya metastatik tümör dokusunda RT-PCR ile değerlendirilmesinin, metastatik prostat kanserli hastalarda prognozu ve tedaviyi belirlemede klinik önemi olduğu gözükmektedir. Ancak bu verinin '' Doğrulayıcı Çalışmalar '' ile desteklenmesi gerekmektedir.
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