Miller David C, Hafez Khaled S, Stewart Andrew, Montie James E, Wei John T
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-0330, USA.
Cancer. 2003 Sep 15;98(6):1169-78. doi: 10.1002/cncr.11635.
Based on the 1998 Patient Care Evaluation (PCE) from the American College of Surgeons National Cancer Data Base (NCDB), the authors described contemporary nationwide patterns of prostate carcinoma presentation, diagnosis, and staging.
The authors reviewed 54,212 cases from the 1998 PCE. Demographics, presenting signs and symptoms, tumor characteristics, prostate biopsy techniques, and use of staging modalities were evaluated.
The mean age of patients in the sample was 68 years. Among patients with available data, 87.5% had a prostate specific antigen (PSA) level of 4 ng/mL or higher, 83.1% had American Joint Committee on Cancer (AJCC) Stage I-II lesions, 80.2% had well or moderately differentiated cancers, and 68.7% of newly diagnosed patients were asymptomatic. Compared with symptomatic patients, asymptomatic patients were more likely to have localized disease (84.6% vs. 78.2%, P < 0.01) and well or moderately differentiated tumors (82.2% vs. 74.6%, P < 0.01). Transrectal ultrasound-guided prostate biopsy was the most common method of tissue confirmation (45.4%). Radionuclide bone scintigraphy was the most frequently employed staging modality (48.7%). Use of various staging evaluations was more frequent among patients at increased risk for disseminated disease (PSA > 10 ng/mL and/or high-grade tumors) versus patients at lower risk (PSA < or = 10 and low to moderate-grade tumors) for metastatic disease (P < 0.005).
Most newly diagnosed patients with prostate carcinoma are asymptomatic and have moderately differentiated and organ-confined disease. Compared with symptomatic patients, tumors in asymptomatic men are associated with lower pretreatment PSA levels, AJCC stage, and tumor grade. Selective use of staging evaluations, based on risk of metastatic disease, may be relatively uncommon. The NCDB remains a unique and rich source of novel patient care information and serves as a national point of reference for prostate carcinoma presentation, diagnosis, and staging.
基于美国外科医师学会国家癌症数据库（NCDB）1998年的患者护理评估（PCE），作者描述了当代全国范围内前列腺癌的呈现、诊断及分期模式。
作者回顾了1998年PCE中的54212例病例。对人口统计学、呈现的体征和症状、肿瘤特征、前列腺活检技术以及分期方式的使用情况进行了评估。
样本中患者的平均年龄为68岁。在有可用数据的患者中，87.5%的前列腺特异性抗原（PSA）水平为4 ng/mL或更高，83.1%患有美国癌症联合委员会（AJCC）I-II期病变，80.2%患有高分化或中分化癌症，68.7%的新诊断患者无症状。经直肠超声引导下前列腺活检是最常见的组织确诊方法（45.4%）。放射性核素骨扫描是最常用的分期方式（48.7%）。与转移性疾病低风险患者（PSA≤10且肿瘤为低至中分级）相比，转移性疾病高风险患者（PSA>10 ng/mL和/或高级别肿瘤）更频繁地使用各种分期评估（P<0.005）。
大多数新诊断的前列腺癌患者无症状，患有中分化且局限于器官的疾病。与有症状的患者相比，无症状男性的肿瘤与较低的治疗前PSA水平、AJCC分期及肿瘤分级相关。基于转移性疾病风险选择性地使用分期评估可能相对不常见。NCDB仍然是新颖的患者护理信息的独特而丰富的来源，并且是前列腺癌呈现、诊断及分期的全国参考点。
