Bott S R J, Young M P A, Kellett M J, Parkinson M C
Institute of Urology and Nephrology, Royal Free and University College Medical School, University College London, UK.
BJU Int. 2002 Jun;89(9):886-9. doi: 10.1046/j.1464-410x.2002.02796.x.
OBJECTIVE; To determine whether anterior prostatic tumours are adequately sampled using the Stamey sextant protocol, as a fifth of prostate cancers are anterior in distribution at radical prostatectomy.
All tumours (62) with an anterior distribution (>or=75% of the tumour anterior to the urethra) on radical prostatectomy whole-mounts, and in which the number and results of the sextant biopsies were available, were extracted from a prostate cancer database. Sixty-one posterior tumours (>or=75% of the malignant tissue posterior to the urethra) and their corresponding sextant biopsies were also retrieved for comparison. The number of biopsy sessions, the number of cores involved and the summated tumour length were recorded, together with the prostate gland weight, the tumour volume and the site of >or=75% of tumour in the superior-inferior axis.
Anterior tumours required significantly more biopsy sessions to diagnose prostate cancer than posterior neoplasms (anterior, one set 47; > one set 15; posterior, one set 57; > one set, four, P=0.007). Anterior tumours had fewer cores with tumour involvement and less summated tumour length than had posterior cancers. The mean (sd) number of positive cores was; anterior 1.8 (1.01), posterior 2.50 (1.30) (P=0.001); the summated tumour length was; anterior 5.05 (4.10) mm, posterior 9.25 (7.80) mm (P<0.001). There was no significant difference in gland weight (mean anterior 43.8 g; posterior 48.3 g, P=0.3) or tumour volume (mean anterior 1.85 mL; posterior 1.49 mL, P=0.11) between the groups. There was no significant difference between the incidence of anterior and posterior neoplasms with respect to their position in the superior-inferior axis (P=0.96).
Anterior prostate tumours account for 21% of all prostate cancers. They more often require multiple sets of sextant biopsies for diagnosis, and yield smaller areas of cancer on core biopsies than do posterior tumours in glands of similar weight and tumour volume. If prostate cancer is suspected clinically but biopsies are negative, targeting the anterior gland at subsequent prostatic biopsy should be considered.
目的；确定使用斯塔米六分区活检法是否能充分采集前列腺前部肿瘤样本，因为在根治性前列腺切除术中，五分之一的前列腺癌分布在前部。
从前列腺癌数据库中提取所有在根治性前列腺切除术全切片上具有前部分布（肿瘤位于尿道前方的比例≥75%）且可获得六分区活检数量及结果的肿瘤（62例）。还检索了61例后部肿瘤（恶性组织位于尿道后方的比例≥75%）及其相应的六分区活检样本进行比较。记录活检次数、取材的活检针数、肿瘤总长度，以及前列腺重量、肿瘤体积和肿瘤在上下轴上≥75%部分的位置。
与后部肿瘤相比，前部肿瘤诊断前列腺癌所需的活检次数显著更多（前部，一组47例；多组15例；后部，一组57例；多组4例，P = 0.007）。前部肿瘤取材的含肿瘤活检针数更少，肿瘤总长度也短于后部癌症。阳性活检针数的均值（标准差）为：前部1.8（1.01），后部2.50（1.30）（P = 0.001）；肿瘤总长度为：前部5.05（4.10）mm，后部9.25（7.80）mm（P < 0.001）。两组间前列腺重量（前部均值43.8 g；后部48.3 g，P = 0.3）或肿瘤体积（前部均值1.85 mL；后部1.49 mL，P = 0.11）无显著差异。前部和后部肿瘤在上下轴上的位置发生率无显著差异（P = 0.96）。
前列腺前部肿瘤占所有前列腺癌的21%。与重量和肿瘤体积相似的腺体中的后部肿瘤相比，它们在诊断时更常需要多组六分区活检，且在穿刺活检中显示的癌灶面积更小。如果临床怀疑前列腺癌但活检结果为阴性，在后续前列腺活检时应考虑针对前部腺体取材。
