Thong Alan E, Shikanov Sergey, Katz Mark H, Gofrit Ofer N, Eggener Scott, Zagaja Gregory P, Shalhav Arieh L, Zorn Kevin C
Department of Surgery, Section of Urology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
J Urol. 2008 Dec;180(6):2436-40. doi: 10.1016/j.juro.2008.08.027. Epub 2008 Oct 19.
Patients with Gleason score 6 microfocal prostate cancer, defined as 5% or less in 1 biopsy core, are often considered to have favorable disease. Few studies have addressed clinical parameters that predict pathological upgrading or up staging at radical prostatectomy.
From a prospective database of 1,271 consecutive robot assisted laparoscopic prostatectomies performed from 2003 to 2008 patients with Gleason score 6 microfocal prostate cancer were identified. Adverse pathological outcome was defined as any upgrading and/or up staging on prostatectomy pathological findings. Multivariate logistic regression was used to evaluate the ability of patient age, clinical stage, the total number of biopsy cores, preoperative prostate specific antigen, prostate volume and pathological prostate specific antigen density to predict adverse pathological outcomes.
A total of 192 patients with a median age of 59 years (range 42 to 73) were identified with Gleason score 6 prostate cancer involving 5% or less of 1 biopsy core, including 177 (92%) with clinical T1c disease. Mean +/- SD preoperative prostate specific antigen was 6.0 +/- 3.9 ng/ml (range 0.8 to 35). Overall 42 patients (22%) had adverse pathological outcomes, including upgrading in 35 (18%) and up staging in 16 (8%). Multivariate logistic regression revealed that age more than 65 years and pathological prostate specific antigen density greater than 0.20 ng/ml/gm were predictive of an increased risk of adverse pathological results (p = 0.0081 and 0.0169, respectively).
While a microfocus of Gleason score 6 prostate cancer on biopsy is commonly considered low risk disease, there was a greater than 1/5 risk of pathological upgrading and/or up staging. Patients with Gleason score 6 microfocal prostate cancer should be counseled that they may harbor more aggressive disease, especially when pretreatment clinical risk factors are present, such as advanced age or high clinical prostate specific antigen density.
Gleason评分6分的微灶性前列腺癌患者（定义为在1个活检组织条中占比5%或更少）通常被认为疾病预后良好。很少有研究探讨预测根治性前列腺切除术后病理升级或分期上升的临床参数。
从2003年至2008年连续进行的1271例机器人辅助腹腔镜前列腺切除术的前瞻性数据库中，识别出Gleason评分6分的微灶性前列腺癌患者。不良病理结果定义为前列腺切除术后病理检查发现的任何升级和/或分期上升。采用多因素逻辑回归分析评估患者年龄、临床分期、活检组织条总数、术前前列腺特异性抗原、前列腺体积和病理前列腺特异性抗原密度预测不良病理结果的能力。
共识别出192例Gleason评分6分的前列腺癌患者，中位年龄59岁（范围42至73岁），肿瘤累及1个活检组织条的5%或更少，其中177例（92%）为临床T1c期疾病。术前前列腺特异性抗原的平均值±标准差为6.0±3.9 ng/ml（范围0.8至35）。总体而言，42例患者（22%）出现不良病理结果，包括35例（18%）升级和16例（8%）分期上升。多因素逻辑回归分析显示，年龄大于65岁和病理前列腺特异性抗原密度大于0.20 ng/ml/gm可预测不良病理结果风险增加（p分别为0.0081和0.0169）。
虽然活检时Gleason评分6分的前列腺癌微灶通常被认为是低风险疾病，但病理升级和/或分期上升的风险大于五分之一。对于Gleason评分6分的微灶性前列腺癌患者，应告知他们可能患有侵袭性更强的疾病，尤其是在存在如高龄或高临床前列腺特异性抗原密度等预处理临床风险因素时。
