Grossklaus D J, Coffey C S, Shappell S B, Jack G S, Cookson M S
Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
BJU Int. 2001 Nov;88(7):722-6. doi: 10.1046/j.1464-4096.2001.02413.x.
To determine what, if any, additional prognostic information is available from the prostate needle biopsy by comparing the number of biopsy cores obtained with the pathology assessed from the radical retropubic prostatectomy (RRP) specimen.
The results from 135 consecutive patients who underwent RRP at a single institution were reviewed. Needle biopsy information (number of cores, percentage of positive cores, laterality of the positive cores, and Gleason sum) were compared with the pathological data of the RRP specimen, including stage, Gleason sum and tumour volume. Patients were further stratified into those with six or fewer cores (96 men) or more than six cores (39 men). Clinical data, including biopsy information and pathological findings, were compared using univariate and multivariate models.
Overall, univariate analysis showed that the total prostate-specific antigen (PSA) level, number of positive cores, bilateral positive cores and percentage of positive cores were directly correlated with tumour volume (P=0.01). Also, PSA and percentage of positive cores were directly correlated with extracapsular extension (P=0.008 and P=0.01, respectively). In the multivariate model, the most important independent predictors of RRP tumour volume and pathological stage were the preoperative PSA level and percentage of cancer in the biopsy (P<0.01). There was no significant relationship between the number of cores obtained and the predicted pathology of the RRP specimen. There were no differences in the number of positive cores, bilateral positive cores or percentage tumour in the cores between men with more or less than six biopsies. In men with more than six core biopsies, there was no significant increase in prognostic information for tumour volume and extracapsular extension, or a correlation between the Gleason sum on biopsy and the RRP specimen. Taking more than six biopsies did not result in a significantly greater detection of potentially indolent tumours (defined as a tumour volume of <0.5 mL).
While taking more prostate needle biopsy cores seems to improve the detection of prostate cancer, there appears to be no major improvement in prognostic information over that gained from traditional sextant biopsies. Furthermore, the results suggest that the percentage of positive cores is the best predictor of both pathological stage and tumour volume, from among the information readily available from prostate needle biopsy. Given the variability in the number of cores obtained for diagnosis in clinical practice, these results add credence to the use of the percentage of positive cores in the biopsy set, with known predictors such as PSA and Gleason score, into future models that attempt to predict tumour biology.
通过比较经直肠前列腺穿刺活检获取的活检组织芯数量与耻骨后根治性前列腺切除术（RRP）标本的病理评估结果，确定是否能从前列腺穿刺活检中获得额外的预后信息。
回顾了在单一机构接受RRP的135例连续患者的结果。将穿刺活检信息（组织芯数量、阳性组织芯百分比、阳性组织芯的侧别以及Gleason评分总和）与RRP标本的病理数据进行比较，包括分期、Gleason评分总和及肿瘤体积。患者进一步分为活检组织芯数量为6个或更少（96例男性）和超过6个（39例男性）两组。使用单变量和多变量模型比较临床数据，包括活检信息和病理结果。
总体而言，单变量分析显示总前列腺特异性抗原（PSA）水平、阳性组织芯数量、双侧阳性组织芯以及阳性组织芯百分比与肿瘤体积直接相关（P = 0.01）。此外，PSA和阳性组织芯百分比与包膜外侵犯直接相关（分别为P = 0.008和P = 0.01）。在多变量模型中，RRP肿瘤体积和病理分期的最重要独立预测因素是术前PSA水平和活检中癌症的百分比（P < 0.01）。获取的组织芯数量与RRP标本的预测病理之间无显著关系。活检组织芯数量多于或少于6个的男性，其阳性组织芯数量、双侧阳性组织芯或组织芯中的肿瘤百分比无差异。在活检组织芯超过6个的男性中，对于肿瘤体积和包膜外侵犯的预后信息没有显著增加，活检的Gleason评分总和与RRP标本之间也无相关性。获取超过6个活检组织芯并未显著增加对潜在惰性肿瘤（定义为肿瘤体积<0.5 mL）的检测。
虽然增加前列腺穿刺活检组织芯数量似乎能提高前列腺癌的检测率，但与传统的六分区活检相比，预后信息似乎没有重大改善。此外，结果表明，从前列腺穿刺活检容易获得的信息中，阳性组织芯百分比是病理分期和肿瘤体积的最佳预测指标。鉴于临床实践中用于诊断的组织芯数量存在差异，这些结果为在未来试图预测肿瘤生物学行为的模型中，将活检组织芯中的阳性组织芯百分比与已知预测指标如PSA和Gleason评分一起使用提供了依据。
