Mouraviev Vladimir, Mayes Janice M, Sun Leon, Madden John F, Moul Judd W, Polascik Thomas J
Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Cancer. 2007 Aug 15;110(4):906-10. doi: 10.1002/cncr.22858.
Early detection of small-volume prostate cancer (PCa) has led to the concept of focal therapy to treat PCa as an organ-sparing, minimally invasive procedure. The authors sought to determine the frequency of unilateral cancers in the contemporary prostate-specific antigen (PSA) era to determine the percentage of patients who would be candidates for hemiablation of the prostate by using focal therapy while preserving the contralateral lobe.
Paraffin-embedded radical prostatectomy specimens (1184 specimens) from consecutive patients between 2002 and 2006 with pathologic organ confined PCa were analyzed. Pathologic assessment focused on tumor laterality and percentage of tumor involvement (PTI) along with other routine parameters such as pathological T-classification (pT), pathological Gleason Score (pGS), extracapsular extension (ECE), and surgical margins (SM). Clinical and pathologic parameters were analyzed by univariate and multivariate methods.
Completely unilateral cancers were identified in 227 (19.2%) of 1184 patients. Of these patients, 164 (72.2%) had PTI of < or =5%, 40 (17.6%) had a PTI of 5.01%-10%, 9 (4.0%) had a PTI of 10.01%-15%, and 14 (6.2%) had a PTI of > 15%, respectively (P < .0005). African-American men had bilateral cancers more commonly that non-African-American men, eg, 90.8% versus 79.2%, respectively (P < .0005). Race, PTI, pGS, and SM were independent predictors by multivariate logistic regression (P < or = .05).
This study suggests that 1 in 5 men diagnosed with PCa have small volume, completely unilateral cancers that may be amenable to hemiablation of the prostate. Further study is needed to develop predictive models to select candidates for focal therapy.
小体积前列腺癌（PCa）的早期检测催生了聚焦治疗的概念，即将PCa作为一种保留器官的微创治疗手段。作者试图确定当代前列腺特异性抗原（PSA）时代单侧癌的发生率，以确定可通过聚焦治疗进行前列腺半消融同时保留对侧叶的患者百分比。
对2002年至2006年间连续接受病理证实为器官局限性PCa患者的石蜡包埋根治性前列腺切除术标本（1184份标本）进行分析。病理评估重点关注肿瘤的侧别、肿瘤累及百分比（PTI）以及其他常规参数，如病理T分期（pT）、病理Gleason评分（pGS）、包膜外侵犯（ECE）和手术切缘（SM）。采用单因素和多因素方法分析临床和病理参数。
1184例患者中有227例（19.2%）为完全单侧癌。在这些患者中，PTI≤5%的有164例（72.2%），PTI为5.01% - 10%的有40例（17.6%），PTI为10.01% - 15%的有9例（4.0%），PTI＞15%的有14例（6.2%）（P＜0.0005）。非裔美国男性比非非裔美国男性更易发生双侧癌，分别为90.8%和79.2%（P＜0.0005）。种族、PTI、pGS和SM是多因素逻辑回归的独立预测因素（P≤0.05）。
本研究表明，每5例被诊断为PCa的男性中就有例为小体积完全单侧癌，可能适合进行前列腺半消融。需要进一步研究以开发预测模型来选择聚焦治疗的候选者。
