Kassouf Wassim, Nakanishi Hiroyuki, Ochiai Atsushi, Babaian Kara N, Troncoso Patricia, Babaian R Joseph
Department of Urology, McGill University Health Center, Montreal, Quebec, Canada.
J Urol. 2007 Jul;178(1):111-4. doi: 10.1016/j.juro.2007.03.013. Epub 2007 May 11.
We investigated the influence of prostate volume on biopsy and prostatectomy Gleason score, the incidence of upgrading and total tumor volume.
From 1997 to 2004, 247 patients were diagnosed with prostate cancer by multisite extended prostatic biopsy (10 or 11 cores) and underwent radical prostatectomy at our institution without neoadjuvant therapy. Medical records were reviewed to determine patient age at diagnosis, preoperative prostate specific antigen, prostate volume, clinical stage, biopsy Gleason score, pathological stage, prostatectomy Gleason score and total tumor volume. The Mann-Whitney and chi-square tests were used to compare variables among groups and multivariate regression analysis was used to determine predictors of Gleason score.
Median patient age was 61 years and median preoperative prostate specific antigen was 5.5 ng/ml. Median prostate volume on transrectal ultrasound was 37 cc. Prostatectomy Gleason score was 6 in 31% of cases, 7 in 57% and 8-9 in 12%. Prostate volume greater than 50 cc was significantly associated with a higher incidence of well differentiated tumors (Gleason score 6) at prostatectomy, that is 17.9% in patients with a prostate volume of 25 cc or less, 28.9% in those with a prostate volume of 25 to 50 cc and 45.3% in those with a prostate volume of greater than 50 cc (p<0.01). In addition, the incidence of tumor upgrading was significantly lower in patients with a large prostate volume (greater than 50 cc) compared to that in those with a smaller prostate volume (20.8% vs 36.1%, p<0.05), particularly in the subset with biopsy Gleason score 6 (24% vs 54.1%, p<0.01). Patients with a large prostate volume (greater than 50 cc) had smaller total tumor volume with a trend toward statistical significance (median total tumor volume 0.86 vs 1.1 cc, p=0.0631).
In the era of extended prostatic biopsies patients with a large prostate volume have a significantly higher incidence of well differentiated tumor at prostatectomy and a lower likelihood of tumor upgrading.
我们研究了前列腺体积对活检及前列腺切除术后Gleason评分、升级发生率和肿瘤总体积的影响。
1997年至2004年期间，247例患者经多部位扩展前列腺活检（10或11针）诊断为前列腺癌，并在我院接受了根治性前列腺切除术，未进行新辅助治疗。回顾病历以确定患者诊断时的年龄、术前前列腺特异性抗原、前列腺体积、临床分期、活检Gleason评分、病理分期、前列腺切除术后Gleason评分和肿瘤总体积。采用Mann-Whitney检验和卡方检验比较组间变量，并使用多因素回归分析确定Gleason评分的预测因素。
患者年龄中位数为61岁，术前前列腺特异性抗原中位数为5.5 ng/ml。经直肠超声检查的前列腺体积中位数为37 cc。前列腺切除术后Gleason评分为6分的病例占31%，7分的占57%，8 - 9分的占12%。前列腺体积大于50 cc与前列腺切除术后高分化肿瘤（Gleason评分6分）的发生率显著相关，即前列腺体积25 cc及以下的患者中为17.9%，25至50 cc的患者中为28.9%，大于50 cc的患者中为45.3%（p<0.01）。此外，前列腺体积大（大于50 cc）的患者肿瘤升级发生率显著低于前列腺体积小的患者（20.8%对36.1%，p<0.05），尤其是活检Gleason评分为6分的亚组（24%对54.1%，p<0.01）。前列腺体积大（大于50 cc）的患者肿瘤总体积较小，有统计学意义的趋势（肿瘤总体积中位数0.86对1.1 cc，p = 0.0631）。
在扩展前列腺活检时代，前列腺体积大的患者前列腺切除术后高分化肿瘤的发生率显著更高，肿瘤升级的可能性更低。
