Loeb Stacy, Roehl Kimberly A, Thaxton C Shad, Catalona William J
Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Urology. 2008 Jul;72(1):143-7. doi: 10.1016/j.urology.2007.11.009. Epub 2008 Apr 24.
Prior studies have reported that men with a PSA density (PSAD) less than 0.15, less than 3 positive biopsy cores, 50% or less of any core involved, and a Gleason score 6 or lower are likely to have "insignificant" prostate cancer (CaP) in their radical prostatectomy (RRP) specimen. In this study, we examined the ability of PSAD and biopsy features to predict pathologic outcomes in a contemporary RRP population.
From 1999 to 2005, 274 men underwent RRP and had the required data for our analysis. As our database does not record the percentage or length of cancer in each biopsy core, we examined the relative importance of PSAD, the number of positive biopsy cores, and Gleason grade to predict "insignificant" cancer, defined as organ-confined with a tumor volume less than 0.5 mL and no Gleason pattern 4 or 5.
Overall, by these criteria, 24.5% of patients were considered to have potentially "insignificant" cancer preoperatively; whereas, only 2.6% had a so-called "insignificant" tumor in the RRP specimen. Without the percentage of biopsy core involvement, the preoperative model to predict "insignificant" cancer was associated with 57% sensitivity, 76% specificity, 6% positive predictive value, and 99% negative predictive value.
A model including Gleason grade, PSAD, and number of positive biopsy cores did not provide an accurate means of selecting patients for active monitoring in our patient cohort. However, it was helpful in identifying men with a high likelihood of "clinically significant" CaP. Knowledge of the percentage of biopsy core involvement with cancer may be a critical prognostic factor.
既往研究报道，前列腺特异抗原密度（PSAD）小于0.15、阳性活检核心小于3个、任何核心受累比例50%或更低以及Gleason评分6分或更低的男性，其根治性前列腺切除术（RRP）标本中可能患有“非显著性”前列腺癌（CaP）。在本研究中，我们检验了PSAD和活检特征预测当代RRP人群病理结果的能力。
1999年至2005年，274名男性接受了RRP手术，并具备我们分析所需的数据。由于我们的数据库未记录每个活检核心中癌症的百分比或长度，我们检验了PSAD、阳性活检核心数量和Gleason分级对预测“非显著性”癌症的相对重要性，“非显著性”癌症定义为器官局限性、肿瘤体积小于0.5 mL且无Gleason模式4或5。
总体而言，根据这些标准，24.5%的患者术前被认为可能患有“非显著性”癌症；而在RRP标本中，只有2.6%的患者患有所谓的“非显著性”肿瘤。在不考虑活检核心受累百分比的情况下，预测“非显著性”癌症的术前模型的敏感性为57%，特异性为76%，阳性预测值为6%，阴性预测值为99%。
在我们的患者队列中，包含Gleason分级、PSAD和阳性活检核心数量的模型并不能提供准确选择患者进行主动监测的方法。然而，它有助于识别具有高可能性的“临床显著性”CaP男性。了解活检核心受累癌症的百分比可能是一个关键的预后因素。
