Djavan B, Mazal P, Zlotta A, Wammack R, Ravery V, Remzi M, Susani M, Borkowski A, Hruby S, Boccon-Gibod L, Schulman C C, Marberger M
Department of Urology University of Vienna, Vienna, Austria.
Prostate. 2001 May 1;47(2):111-7. doi: 10.1002/pros.1053.
We evaluated pathological features of prostate cancer detected on repeat prostate biopsy in men with a serum total prostate-specific antigen (PSA) level between 4 and 10 ng/ml who were diagnosed with benign prostatic tissue after an initial biopsy and compared them to those cancers detected on initial prostate biopsy.
In this prospective European prostate cancer detection study, 1,051 men with a total PSA level between 4 and 10 ng/ml underwent transrectal ultrasound (TRUS)-guided sextant biopsy and two additional transition zone biopsies. All subjects whose biopsy samples were negative for prostate cancer (CaP) underwent a repeat biopsy after 6 weeks. Those with clinically localized cancers underwent radical prostatectomy. Pathological and clinical features of patients diagnosed with cancer on either initial or repeat biopsy and clinically organ confined disease who agreed to undergo radical prostatectomy were compared.
Initial biopsy was positive (CaP) in 231 of 1,051 enrolled subjects and negative (benign histology) in 820 subjects. Of these 820 subjects, CaP was detected in 10% (83/820) upon repeat biopsy. Of cancers detected on initial and repeat biopsy, 148/231 (64%) and 56/83 (67.5%) had clinically localized disease, respectively, and were offered radical prostatectomy. 10/148 (6.7%) and 3/56 (5.3%), respectively, opted for radiation therapy and thus, 138/148 (93.3%) and 53/56 (94.7%), respectively, underwent radical retropubic prostatectomy. There were statistically significant differences with respect to multifocality (P = 0.009) and cancer location (P < 0.001) with cancers on repeat biopsy showing a lower rate of multifocality and a more apico-dorsal location. In contrast, there were no differences with respect to stage (P = 0.2), Gleason score (P = 0.36), percentage Gleason grade 4/5 (P = 0.1), serum PSA (P = 0.62), and patient age (P = 0.517).
At least 10% of patients with negative prostatic biopsy results will be diagnosed with CaP on repeat biopsy. Despite differences in location and multifocality, pathological and biochemical features of cancers detected on initial and repeat biopsy are similar, suggesting similar biological behavior and thus advocating for a repeat prostate biopsy in case of a negative finding on initial biopsy. Cancers missed on initial biopsy and subsequently detected on repeat biopsy are located in a more apico-dorsal location. Repeat biopsies should thus be directed to this rather spared area in order to improve cancer detection rates.
我们评估了血清总前列腺特异性抗原（PSA）水平在4至10 ng/ml之间、初次活检诊断为良性前列腺组织的男性患者重复前列腺活检时检测到的前列腺癌的病理特征，并将其与初次前列腺活检时检测到的癌症进行比较。
在这项前瞻性欧洲前列腺癌检测研究中，1051名总PSA水平在4至10 ng/ml之间的男性接受了经直肠超声（TRUS）引导的六分区活检以及另外两次移行带活检。所有活检样本前列腺癌（CaP）阴性的受试者在6周后接受重复活检。那些临床局限性癌症患者接受了根治性前列腺切除术。比较了在初次或重复活检时诊断为癌症且临床器官局限疾病并同意接受根治性前列腺切除术的患者的病理和临床特征。
1051名入组受试者中，231名初次活检为阳性（CaP），820名初次活检为阴性（良性组织学）。在这820名受试者中，重复活检时10%（83/820）检测到CaP。在初次和重复活检时检测到的癌症中，分别有148/231（64%）和56/83（67.5%）为临床局限性疾病，并接受了根治性前列腺切除术。分别有10/148（6.7%）和3/56（5.3%）选择了放射治疗，因此，分别有138/148（93.3%）和53/56（94.7%）接受了耻骨后根治性前列腺切除术。在多灶性（P = 0.009）和癌症位置（P < 0.001）方面存在统计学显著差异，重复活检的癌症多灶性发生率较低且位于尖 - 背侧位置。相比之下，在分期（P = 0.2）、Gleason评分（P = 0.36）、Gleason 4/5级百分比（P = 0.1）、血清PSA（P = 0.62）和患者年龄（P = 0.517）方面没有差异。
至少10%前列腺活检结果为阴性的患者在重复活检时将被诊断为CaP。尽管在位置和多灶性方面存在差异，但初次和重复活检时检测到的癌症的病理和生化特征相似，提示生物学行为相似，因此主张在初次活检结果为阴性时进行重复前列腺活检。初次活检漏诊而随后在重复活检时检测到的癌症位于更靠尖 - 背侧的位置。因此，重复活检应针对这个相对未被累及的区域，以提高癌症检测率。
