Crawford E David, Wilson Shandra S, Torkko Kathleen C, Hirano Daisaku, Stewart J Scott, Brammell Craig, Wilson R Storey, Kawata Nozomu, Sullivan Holly, Lucia M Scott, Werahera Priya N
Radiation Oncology, Department of Pathology, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO 80045, USA.
BJU Int. 2005 Nov;96(7):999-1004. doi: 10.1111/j.1464-410X.2005.05801.x.
To identify the precise location of prostate cancer within the gland and thus possibly permit more aggressive therapy of the lesion, while potentially sparing the noncancerous gland from ablative therapy.
Three-dimensional "solid" computer models were reconstructed for 86 autopsy specimens and 20 stage T1c radical prostatectomy specimens. Transperineal biopsies were simulated for grid sizes of 5-mm (method A) and 10-mm (method B) with an 18 G, 23-mm long biopsy needle. One or two biopsies per grid point were obtained for a total of 12-108 biopsies, depending on the size of the prostate. Clinically threatening cancers were defined as having volumes of > or = 0.5 mL or Gleason sum > or = 7.
Method A detected significantly more carcinomas than method B in both the autopsy and prostatectomy specimens (autopsy, 72 vs 51; prostatectomy, 50 vs 32, both P < 0.001). Method A also detected more clinically threatening cancers found at autopsy (38/40 vs 31/40, P = 0.008). Among autopsy patients with negative sextant biopsies whose disease was localized to one side, method A detected 72% and method B detected 29-43% (P < 0.001).
The results of this computer simulation show that 5- and 10-mm grid biopsies detect three-quarters and a third, respectively, at autopsy, of patients with the disease localized to one side of the prostate, which may be useful when planning highly selective ablative treatments in the future.
确定前列腺癌在腺体内的确切位置，从而有可能对病变进行更积极的治疗，同时有可能使非癌性腺体免受消融治疗。
为86例尸检标本和20例T1c期根治性前列腺切除术标本重建三维“实体”计算机模型。使用18G、23mm长的活检针模拟经会阴活检，网格大小分别为5mm（方法A）和10mm（方法B）。每个网格点取1或2次活检，根据前列腺大小共取12 - 108次活检。临床有威胁的癌症定义为体积≥0.5 mL或Gleason评分≥7。
在尸检和前列腺切除术标本中，方法A检测到的癌灶均明显多于方法B（尸检：72例对51例；前列腺切除术：50例对32例，P均<0.001）。方法A在尸检中还检测到更多临床有威胁的癌症（38/40对31/40，P = 0.008）。在一侧病变且六分区活检阴性的尸检患者中，方法A检测到72%，方法B检测到29% - 43%（P < 0.001）。
该计算机模拟结果表明，5mm和10mm网格活检在尸检中分别能检测到前列腺一侧病变患者的四分之三及三分之一，这在未来规划高选择性消融治疗时可能有用。
