Gao X, Mohideen N, Flanigan R C, Waters W B, Wojcik E M, Leman C R
Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
J Urol. 2000 Dec;164(6):1982-6.
We identify predictors of extraprostatic extension and positive surgical margins in patients with low risk prostate cancer (prostate specific antigen [PSA] 10 ng./ml. or less, biopsy Gleason score 7 or less and clinical stage T1c-2b).
From August 1997 to January 1999, 143 previously untreated patients underwent radical retropubic prostatectomy for clinically localized prostate cancer. A total of 62 patients were low risk, with PSA 10 ng./ml. or less, biopsy Gleason score 7 or less and clinical stage T1c-2b, and had sextant biopsy with separate pathological evaluation of each sextant cores. PSA, clinical stage, biopsy Gleason score, average percentage of cancer in the entire biopsy specimen, maximum percentage of cancer on the most involved core, number of cores involved and bilaterality were evaluated for association with extraprostatic extension, seminal vesicle involvement and positive surgical margins.
Of the 62 patients 13 (21%) had extraprostatic extension, 6 (10%) seminal vesicle involvement and 20 (32%) positive surgical margins. Average percentage greater than 10% and maximum percentage greater than 25% were associated with extraprostatic extension (p = 0.01 and 0.004, respectively). Average percentage greater than 10%, maximum percentage greater than 25%, more than 2 cores involved and bilaterality were associated with positive surgical margins (p = 0.007, 0.01, 0.002 and 0.03, respectively). On multivariate analysis maximum percentage remained the only independent predictor of extraprostatic extension (p = 0.03), and the number of cores involved remained an independent predictor of positive surgical margins (p = 0.01). Biopsy Gleason score, PSA and clinical stage did not correlate with extraprostatic extension or positive surgical margins in this patient population.
In low risk prostate cancer the extent of biopsy involvement significantly correlates with the risk of extraprostatic extension and positive surgical margins. Biopsy information should be considered when selecting and modifying treatment modalities.
我们确定低风险前列腺癌（前列腺特异性抗原[PSA]10 ng/ml或更低、活检Gleason评分7或更低且临床分期T1c - 2b）患者前列腺外侵犯及手术切缘阳性的预测因素。
1997年8月至1999年1月，143例先前未接受治疗的患者因临床局限性前列腺癌接受了耻骨后根治性前列腺切除术。共有62例患者为低风险，PSA为10 ng/ml或更低、活检Gleason评分7或更低且临床分期T1c - 2b，并进行了六分区活检，对每个分区的组织芯进行单独病理评估。评估PSA、临床分期、活检Gleason评分、整个活检标本中癌的平均百分比、受累最严重组织芯上癌的最大百分比、受累组织芯数量及双侧性与前列腺外侵犯、精囊受累及手术切缘阳性的相关性。
62例患者中，13例（21%）有前列腺外侵犯，6例（10%）有精囊受累，20例（32%）手术切缘阳性。平均百分比大于10%及最大百分比大于25%与前列腺外侵犯相关（分别为p = 0.01和0.004）。平均百分比大于10%、最大百分比大于25%、受累组织芯超过2个及双侧性与手术切缘阳性相关（分别为p = 0.007、0.01、0.002和0.03）。多因素分析显示，最大百分比仍然是前列腺外侵犯的唯一独立预测因素（p = 0.03），受累组织芯数量仍然是手术切缘阳性的独立预测因素（p = 0.01）。在该患者群体中，活检Gleason评分、PSA和临床分期与前列腺外侵犯或手术切缘阳性无相关性。
在低风险前列腺癌中，活检受累程度与前列腺外侵犯及手术切缘阳性风险显著相关。在选择和调整治疗方式时应考虑活检信息。
