Turley Ryan S, Hamilton Robert J, Terris Martha K, Kane Christopher J, Aronson William J, Presti Joseph C, Amling Christopher L, Freedland Stephen J
Division of Urological Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina, USA.
J Urol. 2008 Feb;179(2):523-7; discussion 527-8. doi: 10.1016/j.juro.2007.09.078.
Needle biopsy Gleason scores are often upgraded after pathological examination of the prostate following radical prostatectomy. It has been suggested that larger prostates would be associated with a greater risk of upgrading since a smaller percentage of the gland is sampled and, thus, the highest grade disease would more likely be missed, assuming an equal number of cores is taken from similar locations. We examined the likelihood of clinically relevant upgrading after radical prostatectomy as a function of transrectal ultrasound volume.
We examined the association between transrectal ultrasound volume and upgrading (higher Gleason score category in the radical prostatectomy specimen than in the biopsy) in 586 men treated with radical prostatectomy between 1995 and 2006 in the SEARCH database who underwent at least a sextant biopsy using multivariate logistic regression. Transrectal ultrasound volume was categorized as 20 or less (in 71), 21 to 40 (in 334), 41 to 60 (in 123) and greater than 60 cm(3) (in 58). Gleason score was examined as a categorical variable of 2-6, 3 + 4 and 4 + 3 or greater.
Overall 138 cases (24%) were upgraded, 80 (14%) were downgraded, and 368 (62%) had identical biopsy and pathological Gleason sum groups. Larger transrectal ultrasound volume was significantly associated with decreased likelihood of upgrading (p trend <0.001). For transrectal ultrasound volumes greater than 60, 41 to 60, 21 to 40 and 20 cm(3) or less, the estimated multivariate adjusted probability of upgrading was 12.6%, 27.5%, 36.4% and 45.5% for Gleason 2-6 tumors, and 6.1%, 8.5%, 18.9% and 20.9% for Gleason 3 + 4 tumors, respectively.
Larger transrectal ultrasound volumes were at decreased risk for clinically significant upgrading after radical prostatectomy. This fact should be kept in mind when deciding on treatment decisions for men with apparently low grade prostate cancer on biopsy.
在根治性前列腺切除术后对前列腺进行病理检查后，穿刺活检的Gleason评分常常会被上调。有人提出，更大的前列腺可能与更高的上调风险相关，因为所取腺体的百分比更小，因此，假设从相似部位取相同数量的组织芯，最高分级的疾病更有可能被漏检。我们研究了根治性前列腺切除术后临床相关上调的可能性与经直肠超声测量体积之间的关系。
我们在SEARCH数据库中研究了1995年至2006年间接受根治性前列腺切除术且至少进行过一次六分区活检的586名男性患者，使用多因素逻辑回归分析经直肠超声测量体积与上调（根治性前列腺切除标本中的Gleason评分类别高于活检标本）之间的关联。经直肠超声测量体积被分为20 cm³及以下（71例）、21至40 cm³（334例）、41至60 cm³（123例）和大于60 cm³（58例）。Gleason评分被视为2 - 6、3 + 4以及4 + 3或更高的分类变量。
总体而言，138例（24%）出现上调，80例（14%）出现下调，368例（62%）活检和病理Gleason总分分组相同。更大的经直肠超声测量体积与上调可能性降低显著相关（p趋势<0.001）。对于Gleason 2 - 6肿瘤，经直肠超声测量体积大于60 cm³、41至60 cm³、21至40 cm³以及20 cm³及以下时，多因素调整后的上调估计概率分别为12.6%、27.5%、36.4%和45.5%；对于Gleason 3 + 4肿瘤，上述体积分组对应的上调估计概率分别为6.1%、8.5%、18.9%和20.9%。
更大的经直肠超声测量体积在根治性前列腺切除术后出现临床显著上调的风险较低。在为活检显示为明显低级别前列腺癌的男性患者制定治疗决策时，应牢记这一事实。
