Guzzo Thomas J, Levin Brian M, Lee Richard, Guo Mengye, Chen Zhen, Whittington Richard, Tomaszewski John, Malkowicz S Bruce
Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Urology. 2008 Apr;71(4):723-7. doi: 10.1016/j.urology.2007.09.027.
Recent studies have demonstrated that the percentage of positive prostate needle biopsies (PPBs) is an independent predictor of biochemical failure (BF) after radical prostatectomy and external beam radiotherapy. Few studies have confirmed this phenomenon in patients treated with permanent interstitial brachytherapy. We conducted an analysis to determine the clinical utility of the PPBs in predicting BF after permanent interstitial brachytherapy for patients with clinically localized prostate cancer.
The clinical and pathologic data from 245 hormone-naive patients with clinical Stage T1c-T2cNxM0 prostate cancer who had undergone permanent prostate brachytherapy from 1992 to 2002 at our institution were retrospectively evaluated. The PPBs, preimplant prostate-specific antigen, and biopsy Gleason score were evaluated as predictors of BF after brachytherapy. The risk of BF was calculated using logistic regression models. The time to BF was assessed using Cox proportional hazard models and Kaplan-Meier estimates.
The median PPBs in our study cohort was 27%. The risk of BF was 10.9% for those with a PPBs less than the median versus 26.2% for those with a PPBs greater than the median. A PPBs greater than the median was an independent predictor of BF on multivariate analysis (relative risk 2.3, 95% confidence interval 1.21 to 4.39, P = 0.011). In the time-to-failure models, the PPBs, prostate-specific antigen level, and Gleason score were significantly associated with BF.
Our data suggest that the PPBs is significantly associated with BF in patients undergoing permanent interstitial brachytherapy. The PPBs, along with the pretreatment prostate-specific antigen level and Gleason biopsy score, is a useful preoperative parameter in predicting for BF and the time to failure for patients treated with interstitial brachytherapy.
近期研究表明，前列腺穿刺活检阳性率（PPBs）是根治性前列腺切除术和外照射放疗后生化复发（BF）的独立预测因素。很少有研究在接受永久性间质内近距离放射治疗的患者中证实这一现象。我们进行了一项分析，以确定PPBs在预测临床局限性前列腺癌患者接受永久性间质内近距离放射治疗后BF的临床效用。
回顾性评估了1992年至2002年在我院接受永久性前列腺近距离放射治疗的245例未经激素治疗、临床分期为T1c - T2cNxM0的前列腺癌患者的临床和病理数据。将PPBs、植入前前列腺特异性抗原和活检Gleason评分作为近距离放射治疗后BF的预测因素。使用逻辑回归模型计算BF风险。使用Cox比例风险模型和Kaplan - Meier估计评估BF发生时间。
我们研究队列中的PPBs中位数为27%。PPBs低于中位数的患者BF风险为10.9%，而PPBs高于中位数的患者BF风险为26.2%。多因素分析显示，PPBs高于中位数是BF的独立预测因素（相对风险2.3，95%置信区间1.21至4.39，P = 0.011）。在失败时间模型中，PPBs、前列腺特异性抗原水平和Gleason评分与BF显著相关。
我们的数据表明，接受永久性间质内近距离放射治疗的患者中，PPBs与BF显著相关。PPBs连同治疗前前列腺特异性抗原水平和Gleason活检评分，是预测接受间质内近距离放射治疗患者BF及失败时间的有用术前参数。
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