Djavan B, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M, Seitz C, Susani M, Borkowski A, Boccon-Gibod L, Schulman C C, Marberger M
Department of Urology, University of Vienna, Vienna, Austria.
J Urol. 2001 Nov;166(5):1679-83.
We evaluated biochemical parameters and pathological features, as well as biopsy related morbidity of prostate cancer detected on biopsies 2, 3 and 4 in men with total serum prostate specific antigen (PSA) between 4 and 10 ng./ml. These features were compared to those detected on prostate biopsy 1.
In this prospective European Prostate Cancer Detection study 1,051 men with total PSA between 4 and 10 ng./ml. underwent transrectal ultrasound guided sextant biopsy and 2 additional transition zone biopsies. All patients in whom biopsy samples were negative for prostate cancer underwent biopsy 2 after 6 weeks. If also negative, biopsies 3 and even 4 were performed at 8-week intervals. Those patients with clinically localized cancer underwent radical prostatectomy. Pathological and clinical features of patients diagnosed with cancer on either biopsy 1 or 2 and clinically organ confined disease who agreed to undergo radical prostatectomy were compared.
Cancer detection rates on biopsies 1, 2, 3 and 4 were 22% (231 of 1,051), 10% (83 of 820), 5% (36 of 737) and 4% (4 of 94), respectively. Overall, of the patients with clinically localized disease, which was 67% of cancers detected, 86% underwent radical prostatectomy and 14% opted for watchful waiting or radiation therapy. Overall, 58.0%, 60.9%, 86.3% and 100% of patients had organ confined disease on biopsies 1, 2, 3 and 4, respectively. Despite statistically significant differences in regard to multifocality (p = 0.009) and cancer location (p = 0.001), including cancer on biopsy 2 showing a lower rate of multifocality and a more apico-dorsal location, there were no differences in regard to stage (p = 0.2), Gleason score (p = 0.3), percent Gleason grade 4/5 (p = 0.2), serum PSA and patient age between biopsies 1 and 2. However, cancer detected on biopsies 3 and 4 had a significantly lower Gleason score (p = 0.001 and 0.001), lower rate of grade 4/5 (p = 0.02), and lower volume (p = 0.001 and 0.001) and stage (p = 0.001), respectively.
Despite differences in location and multifocality, pathological and biochemical features of cancer detected on biopsies 1 and 2 were similar, suggesting comparable biological behaviors. Cancer detected on biopsies 3 and 4 had a lower grade, stage and volume compared with that on biopsies 1 and 2. Morbidity on biopsies 1 and 2 was similar, whereas biopsies 3 and 4 had a slightly higher complication rate. Therefore, biopsy 2 in all cases of a negative finding on biopsy 1 appears justified. However, biopsies 3 and 4 should only be obtained in select patients with a high suspicion of cancer and/or poor prognostic factors on biopsy 1 or 2.
我们评估了血清总前列腺特异性抗原（PSA）在4至10 ng/ml的男性患者中，第2、3和4次活检时检测到的前列腺癌的生化参数、病理特征以及活检相关的发病率。并将这些特征与第1次前列腺活检时检测到的特征进行比较。
在这项前瞻性欧洲前列腺癌检测研究中，1051名血清总PSA在4至10 ng/ml的男性接受了经直肠超声引导的六分区活检及另外2次移行带活检。所有前列腺癌活检样本为阴性的患者在6周后接受第2次活检。如果仍为阴性，则分别在8周间隔时进行第3次甚至第4次活检。那些临床局限性癌患者接受了根治性前列腺切除术。比较了在第1次或第2次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。
第1、2、3和4次活检时的癌症检出率分别为22%（1051例中的231例）、10%（820例中的83例）、5%（737例中的36例）和4%（94例中的4例）。总体而言，临床局限性疾病患者占检测到癌症患者的67%，其中86%接受了根治性前列腺切除术，14%选择了观察等待或放射治疗。总体而言，第1、2、3和4次活检时分别有58.0%、60.9%、86.3%和100%的患者患有器官局限性疾病。尽管在多灶性（p = 0.009）和癌症位置（p = 0.001）方面存在统计学显著差异，包括第2次活检时的癌症多灶性发生率较低且位于尖部-背侧位置，但在第1次和第2次活检之间，分期（p = 0.2）、Gleason评分（p = 0.3）、Gleason 4/5级百分比（p = 0.2）、血清PSA和患者年龄方面没有差异。然而，第3次和第4次活检时检测到的癌症Gleason评分显著较低（p = 0.001和0.001），4/5级发生率较低（p = 0.02），体积（p = 0.001和0.001）和分期（p = 0.001）也较低。
尽管在位置和多灶性方面存在差异，但第1次和第2次活检时检测到的癌症的病理和生化特征相似，表明生物学行为具有可比性。与第1次和第2次活检相比，第3次和第4次活检时检测到的癌症分级、分期和体积较低。第1次和第2次活检的发病率相似，而第3次和第4次活检的并发症发生率略高。因此，对于第1次活检结果为阴性的所有病例，进行第2次活检似乎是合理的。然而，仅应在第1次或第2次活检时高度怀疑癌症和/或预后不良因素的特定患者中进行第3次和第4次活检。
