Yang X J, Lecksell K, Potter S R, Epstein J I
Department of Pathology and James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.
Urology. 1999 Sep;54(3):528-32. doi: 10.1016/s0090-4295(99)00166-1.
With increased screening for prostate cancer, we have noted a greater number of patients with small foci of Gleason score 7 or greater prostate cancer on needle biopsy. The significance of these findings is unknown.
We studied 57 men with small foci of Gleason score 7 or greater on needle biopsy. Tumor length was less than 1.5 mm in all but 2 cases. In those 2 cases, there were two minute (less than 0.5 mm) foci of cancer separated by 1.8 mm. The length of cancer ranged from 0.2 to 1.8 mm (mean 0.63 mm). In all cases, only one core was involved.
Thirty-three men underwent radical prostatectomy (RP), 14 received radiation, 8 underwent surveillance, and 2 received hormonal therapy. Men who underwent RP were younger (62 years) than those who had radiotherapy (69.1 years), who were younger than those who underwent surveillance (74.5 years). The mean prostate-specific antigen (PSA) for men undergoing RP was 8.0 ng/mL (range 1.4 to 22). Preoperative serum PSA values did not predict organ-confined status. Needle biopsy grades were as follows: 3 + 4 = 7 (n = 30); 4 + 3 = 7 (n = 17); 4 + 4 = 8 (n = 7); 5 + 4 = 9 (n = 1); and 5 + 5 = 10 (n = 2). We were able to review slides in 27 of the RP specimens, of which 24 were well sampled. Of these 24 cases, 33% had positive margins and 33% were not organ confined; the median tumor volume was 0.5 cc (mean 1.04). No difference in RP tumor volume was found between tumors with needle biopsy Gleason primary grade 3 and those with 4 or greater. The percentage of Gleason pattern 4 on needle biopsy weakly correlated with the percentage of Gleason pattern 4 in the RP specimen (P = 0.04). However, the percentage of Gleason pattern 4 only in the RP specimen, but not in the biopsy, correlated with whether the tumor was organ confined.
The likelihood of having organ-confined disease with small foci of Gleason score 7 or greater on needle biopsy appears to be equivalent to that calculated from the Partin Tables for greater amounts of Gleason score 6 cancer on needle biopsy. In men who are considering RP, small foci of Gleason score 7 or greater adenocarcinoma on needle biopsy should not necessarily be considered an adverse finding.
随着前列腺癌筛查的增加，我们注意到针吸活检中出现更多 Gleason 评分 7 分及以上的小病灶前列腺癌患者。这些发现的意义尚不清楚。
我们研究了 57 例针吸活检中有 Gleason 评分 7 分及以上小病灶的男性。除 2 例患者外，所有患者肿瘤长度均小于 1.5 毫米。在这 2 例患者中，有两个微小（小于 0.5 毫米）的癌灶，相距 1.8 毫米。癌灶长度为 0.2 至 1.8 毫米（平均 0.63 毫米）。所有病例均仅一个穿刺针芯受累。
33 名男性接受了根治性前列腺切除术（RP），14 名接受了放疗，8 名接受了监测，2 名接受了激素治疗。接受 RP 的男性（62 岁）比接受放疗的男性（69.1 岁）年轻，而接受放疗的男性又比接受监测的男性（74.5 岁）年轻。接受 RP 的男性的平均前列腺特异性抗原（PSA）为 8.0 ng/mL（范围 1.4 至 22）。术前血清 PSA 值不能预测肿瘤是否局限于器官。针吸活检分级如下：3 + 4 = 7（n = 30）；4 + 3 = 7（n = 17）；4 + 4 = 8（n = 7）；5 + 4 = 9（n = 1）；5 + 5 = 10（n = 2）。我们能够复查 27 例 RP 标本的切片，其中 24 例取材良好。在这 24 例病例中，33%切缘阳性，33%肿瘤未局限于器官；中位肿瘤体积为 0.5 立方厘米（平均 1.04）。针吸活检 Gleason 主要分级为 3 级的肿瘤与 4 级及以上的肿瘤在 RP 肿瘤体积上无差异。针吸活检中 Gleason 4 级模式的百分比与 RP 标本中 Gleason 4 级模式的百分比呈弱相关（P = 0.04）。然而，仅 RP 标本中而非活检中 Gleason 4 级模式的百分比与肿瘤是否局限于器官相关。
针吸活检中有 Gleason 评分 7 分及以上小病灶的患者出现肿瘤局限于器官的可能性似乎与 Partin 表格中针对针吸活检中 Gleason 评分 6 分较多的情况所计算出的可能性相当。对于考虑进行 RP 的男性，针吸活检中有 Gleason 评分 7 分及以上的小病灶腺癌不一定应被视为不良发现。
