Ghavamian R, Blute M L, Bergstralh E J, Slezak J, Zincke H
Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
Urology. 1999 Jul;54(1):105-10. doi: 10.1016/s0090-4295(99)00055-2.
Serum prostate-specific antigen (PSA) testing has led to increased detection of clinically localized prostate cancer. We analyzed the clinical characteristics and outcome of digitally palpable (cT2) and PSA detected (cT1c) prostate cancers.
We evaluated 4453 patients with clinically localized prostate cancer who underwent radical retropubic prostatectomy (RRP) between 1987 and 1995 at the Mayo Clinic. Overall, 1041 (23.4%), 1076 (24.2%), and 2336 (52.5%) patients had cT1c, cT2a, and cT2b/c disease, respectively. Patients were analyzed with regard to Gleason score, preoperative PSA, pathologic stage, deoxyribonucleic acid (DNA) ploidy, margin status, tumor volume, and adjuvant treatment. Survival outcomes at 5 and 7 years were estimated using the Kaplan-Meier method with respect to the end points of systemic/local clinical progression and clinical and/or PSA progression (greater than 0.2 microg/mL). Multivariate analysis was employed to estimate the relative risk of progression associated with each clinical stage when adjusted for the above factors.
Clinical T1c tumors were more likely to be organ confined (76% versus 54%), have a Gleason score less than 7 (75% versus 61%), and be diploid (80% versus 70%) than cT2b/c tumors (P <0.001). Clinical T1c disease closely resembled cT2b/c disease with respect to preoperative PSA. Considering pathologic stage, DNA ploidy, and tumor volume, cT1c tumors were comparable to cT2a lesions. Of the patients with T1c cancers, 96.2% had clinically significant cancer on the basis of pathologic grade and tumor volume. The 5 (and 7 year) systemic/local clinical progression-free and PSA progression-free survivals for cT1c tumors were 97.7+/-0.7% (96.4+/-1.1%) and 82.2+/-1.7% (72.9+/-3.8%), respectively. There was a significant survival advantage at 5 and 7 years regarding both end points for cT1c and cT2a compared with cT2b/c tumors (P <0.001). Multivariate analysis revealed a continued benefit in PSA and systemic/local clinical progression for cT1c tumors compared with cT2b/c tumors adjusting for the above factors.
Clinical T1c tumors are clinically significant cancers. When compared with digitally palpable tumors, progression-free survival rates for cT1c tumors are similar to cT2a lesions, but are significantly better than cT2b/c lesions. This supports continued use of serum PSA to detect potentially curable prostate cancer.
血清前列腺特异性抗原（PSA）检测使临床局限性前列腺癌的检出率有所提高。我们分析了通过直肠指诊（cT2）和PSA检测（cT1c）发现的前列腺癌的临床特征及预后。
我们评估了1987年至1995年间在梅奥诊所接受根治性耻骨后前列腺切除术（RRP）的4453例临床局限性前列腺癌患者。总体而言，分别有1041例（23.4%）、1076例（24.2%）和2336例（52.5%）患者患有cT1c、cT2a和cT2b/c期疾病。对患者的Gleason评分、术前PSA、病理分期、脱氧核糖核酸（DNA）倍体、切缘状态、肿瘤体积及辅助治疗情况进行了分析。采用Kaplan-Meier法估计5年和7年时系统性/局部临床进展及临床和/或PSA进展（大于0.2μg/mL）终点的生存预后。采用多变量分析来估计在对上述因素进行校正后，与各临床分期相关的进展相对风险。
与cT2b/c期肿瘤相比，临床T1c期肿瘤更有可能局限于器官内（76%对54%），Gleason评分小于7（75%对61%），且为二倍体（80%对70%）（P<0.001）。临床T1c期疾病在术前PSA方面与cT2b/c期疾病相似。考虑到病理分期、DNA倍体和肿瘤体积，cT1c期肿瘤与cT2a期病变相当。在T1c期癌患者中，96.2%的患者基于病理分级和肿瘤体积患有具有临床意义的癌症。cT1c期肿瘤的5年（和7年）系统性/局部无临床进展生存率及无PSA进展生存率分别为97.7±0.7%（96.4±1.1%）和82.2±1.7%（72.9±3.8%）。与cT2b/c期肿瘤相比，cT1c期和cT2a期在5年和7年时在两个终点方面均具有显著的生存优势（P<）。多变量分析显示，在对上述因素进行校正后，与cT2b/c期肿瘤相比，cT1c期肿瘤在PSA及系统性/局部临床进展方面仍具有优势。
临床T1c期肿瘤是具有临床意义的癌症。与直肠指诊可触及的肿瘤相比，cT1c期肿瘤的无进展生存率与cT2a期病变相似，但显著优于cT2b/c期病变。这支持继续使用血清PSA来检测潜在可治愈的前列腺癌。
