Choo R, Danjoux C, Morton G, Szumacher E, Sugar L, Gardner S, Kim M, Choo C M, Klotz L
Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
Prostate. 2007 Nov 1;67(15):1614-20. doi: 10.1002/pros.20648.
To compare histologic grades between an initial biopsy and a follow-up biopsy in untreated, Gleason score (GS) 4-7, clinically localized prostate cancer.
In a prospective single-arm cohort study, clinically localized, GS 4-7, prostate cancer was managed with active surveillance alone, provided that a pre-defined definition of disease progression was not met. One hundred five (63%) of a total of 168 eligible patients underwent a follow-up prostate biopsy during surveillance. Median time to a follow-up biopsy was 22 months (range: 7-81). Histologic grades between these two biopsies were compared to evaluate the extent of histologic grade change.
On the follow-up biopsy, GS was unchanged in 33 patients (31%), upgraded in 37 (35%), and downgraded in 34 (32%). Eleven (10%) had upgrading by 2 Gleason points or more. Eight (8%) had upgrading to GS 8 (none to GS 9 or 10); of these, six were among those with upgrading by 2 Gleason points or more. Twenty-seven (26%) had no malignancy on the follow-up biopsy. Negative follow-up biopsy was more prevalent in patients with a small volume of malignancy in the initial biopsy and a low baseline PSA.
No consistent change in histologic grade was observed on the follow-up biopsy at a median of 22 months in untreated, GS 4-7, clinically localized prostate cancer. Upgrading to GS > or =8 or by 2 Gleason points or more was relatively uncommon.
比较未经治疗的 Gleason 评分（GS）4 - 7 分的临床局限性前列腺癌患者初次活检与随访活检的组织学分级。
在一项前瞻性单臂队列研究中，对于临床局限性、GS 4 - 7 分的前列腺癌患者，若未达到疾病进展的预定义标准，则仅进行主动监测。168 例符合条件的患者中有 105 例（63%）在监测期间接受了随访前列腺活检。随访活检的中位时间为 22 个月（范围：7 - 81 个月）。比较这两次活检的组织学分级，以评估组织学分级变化的程度。
在随访活检中，33 例患者（31%）的 GS 未改变，37 例（35%）升级，34 例（32%）降级。11 例（10%）Gleason 评分升高 2 分或更多。8 例（8%）升级至 GS 8（无升级至 GS 9 或 10 的患者）；其中，6 例属于 Gleason 评分升高 2 分或更多的患者。27 例（26%）在随访活检中未发现恶性肿瘤。随访活检结果为阴性在初次活检时恶性肿瘤体积较小且基线 PSA 较低的患者中更为常见。
在未经治疗的 GS 4 - 7 分的临床局限性前列腺癌患者中，随访活检（中位时间 22 个月）时未观察到组织学分级的一致变化。升级至 GS≥8 或 Gleason 评分升高 2 分或更多相对不常见。
