McNeal J E, Haillot O
Department of Urology, Stanford University Medical Center, California 94305, USA.
Prostate. 2001 Sep 15;49(1):48-57. doi: 10.1002/pros.1117.
Peripheral zone (PZ) and transition zone (TZ) cancers of the prostate remain confined to their zone of origin under 4 cc volume, with progressive molding to TZ boundary. In PZ cancer, growth in perineural spaces over 4 cc volume directs cancer toward the base, around subcapsular nerve trunks, and often transcapsular. This tendency to stereotyped patterns of cancer spread in the prostate is investigated systematically here for the first time.
Cancers in 571 radical prostatectomy specimens were sorted by zone of origin and tumor volume. A traced map of each cancer at 3 mm transverse intervals was assessed for location, contour, selected linear measures and the "transverse (largest) reference plane".
Spread along prostate capsule characterized all but the smallest PZ cancers and was most extensive transversely. By 4 cc volume, most PZ cancers' transverse reference plane filled one side of PZ. Above 4 cc, bilateral spread, TZ invasion, and nodularity progressively increased, but dominant growth was toward the base along nerves to the superior pedicle; here capsule penetration was most common. TZ cancers arose mainly in anterior-mid TZ, invading anterior fibromuscular stroma (AFM) while small. AFM was massively invaded in many large tumors. Larger TZ cancers (> 4 cc) invaded anterolateral PZ but seldom penetrated posterior PZ.
Patterns and extent of spread of carcinoma in the prostate are stereotyped following a few principles regarding stromal interactions. Using these, sequential maps were presented of evolving prostate cancer contours at consecutive increasing volumes.
前列腺外周带（PZ）癌和移行带（TZ）癌在体积小于4立方厘米时仍局限于其起源区域，并逐渐向TZ边界塑形。在PZ癌中，体积超过4立方厘米时在神经周围间隙的生长会使癌症朝着基部、围绕包膜下神经干扩散，且常穿透包膜。本文首次系统地研究了前列腺癌这种刻板的扩散模式。
对571例根治性前列腺切除术标本中的癌症按起源区域和肿瘤体积进行分类。以3毫米的横向间隔对每个癌症绘制追踪图，评估其位置、轮廓、选定的线性测量值以及“横向（最大）参考平面”。
除最小的PZ癌外，所有癌症均有沿前列腺包膜扩散的特征，且横向扩散最为广泛。当体积达到4立方厘米时，大多数PZ癌的横向参考平面占据PZ的一侧。体积超过4立方厘米时，双侧扩散、TZ侵犯和结节状逐渐增加，但主要生长方向是沿着神经向基部至上级蒂；此处包膜穿透最为常见。TZ癌主要起源于前中部TZ，在较小时侵犯前部纤维肌基质（AFM）。许多大肿瘤中AFM被大量侵犯。较大的TZ癌（>4立方厘米）侵犯前外侧PZ，但很少穿透后PZ。
前列腺癌的扩散模式和范围遵循一些关于基质相互作用的原则，具有刻板性。利用这些原则，展示了随着体积不断增加，前列腺癌轮廓演变的连续图谱。
