Calvete Antonio Carlos, Srougi Miguel, Nesrallah Luciano Jo o, Dall'Oglio Marcos Francisco, Ortiz Valdemar
Universidad Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil.
Rev Assoc Med Bras (1992). 2003 Jul-Sep;49(3):250-4. doi: 10.1590/s0104-42302003000300026. Epub 2003 Nov 5.
To valuate the behavior of the prostatic biopsy fragments percentage, guided by transrectal ultrasonography in extraprostatic disease prediction in patients with localized adenocarcinoma of the prostate gland and, also, to compare the efficiency of this pattern with them got by the valuation of PSA and preoperative Gleason score.
This retrospective non-controlled study consisted of 522 patients with adenocarcinoma located in the prostate. They were submitted to surgical treatment through retropubic radical prostatectomy. The ages of the patients ranged from 42 to 76 years with a mean of 62.44 years. All of them were submitted to transrectal ultrasonography with prostatic biopsy (direct of the lesion and/or suspected area and sextant) previous to the radical surgical treatment. The 522 patients were divided in groups according to the positive fragments found by the biopsy, what was correlated with the anatomicpathologic findings of intraprostatic disease (limited to the gland) and extraprostatic (invasion periprostatic adiposity and/or the bladder neck and/or the seminal vesicles and/or positive pelvic lymph nodes) of the surgical specimen.
Regarding the analysis of the positive fragments percentage, the groups G1 (0-25%), G2 (20-50%) and G3 (51-75%) showed an incidence of the intraprostatic disease two and three times greater than the extraprostatic one. However, when more than 75% of the biopsy fragments were positive (G4, 76-100%), the relation inverted occurring a predominance of the extraprostatic disease over the intraprostatic. In this group 56.98% of the patients showed extraprostatic disease. There was a statistically significant difference of the extraprostatic disease between the groups G3 and G4 (p 0.0068).
When we compared the three inconstant to evaluate the efficiency order anticipating extraprostatic disease, we verified that the preoperative PSA was the most discriminated (p = 0.000000) followed by the Gleason score of prostatic biopsy (p = 0.000003) and by the positive biopsies percentage (p = 0.000574).
评估经直肠超声引导下前列腺穿刺活检组织碎片百分比在预测局限性前列腺腺癌患者前列腺外疾病中的表现，并将该模式的效率与通过前列腺特异性抗原（PSA）评估及术前Gleason评分所获得的效率进行比较。
这项回顾性非对照研究纳入了522例前列腺腺癌患者。他们均接受了耻骨后根治性前列腺切除术。患者年龄在42至76岁之间，平均年龄为62.44岁。所有患者在根治性手术治疗前均接受了经直肠超声引导下的前列腺穿刺活检（针对病变和/或可疑区域以及六分区）。根据穿刺活检发现的阳性组织碎片，将522例患者分组，这与手术标本中前列腺内疾病（局限于腺体）和前列腺外疾病（侵犯前列腺周围脂肪和/或膀胱颈和/或精囊和/或盆腔淋巴结阳性）的解剖病理学结果相关。
关于阳性组织碎片百分比的分析，G1组（0 - 25%）、G2组（20 - 50%）和G3组（51 - 75%）中前列腺内疾病的发生率比前列腺外疾病高两到三倍。然而，当超过75%的穿刺活检组织碎片为阳性时（G4组，76 - = 100%），这种关系发生反转，前列腺外疾病占主导地位。在该组中，56.98%的患者出现前列腺外疾病。G3组和G4组之间前列腺外疾病存在统计学显著差异（p = 0.0068）。
当我们比较用于评估预测前列腺外疾病效率的三个变量时，我们发现术前PSA的区分度最高（p = 0.000000），其次是前列腺穿刺活检的Gleason评分（p = 0.000003），然后是阳性活检百分比（p = 0.000574）。
