Nakanishi Hiroyuki, Troncoso Patricia, Babaian R Joseph
Departments of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
J Urol. 2008 Dec;180(6):2441-5; discussion 2445-6. doi: 10.1016/j.juro.2008.08.023. Epub 2008 Oct 19.
Recent data have shown that high grade prostate cancer is a potentially surgically curable disease in properly selected patients. We assessed the ability of preoperative variables to predict extraprostatic extension in men with biopsy Gleason score 8 or greater.
We identified 159 patients who underwent prostatectomy without neoadjuvant therapy for biopsy proven Gleason score 8 or greater T1c-T2N0M0 cancer between 1996 and 2006. Univariate and multivariate analyses were performed to predict extraprostatic extension using side specific data, including clinical features and biopsy findings.
Organ confined cancer was pathologically confirmed in 84 of 159 patients (52.8%). Side specific analysis was practicable on 124 sides (124 men) and side specific extraprostatic extension was found on 48 of the 124 sides (38.7%). Gleason grade 5 element, maximum tumor length, percent of positive cores, positive basal cores and side specific palpable disease were significantly associated with side specific extraprostatic extension. On multivariate analysis maximum tumor length and a positive basal core were independent predictors of side specific extraprostatic extension (p <0.001 and 0.033, respectively). When maximum tumor length was less than 7 mm and the basal core was negative for cancer, the incidence of side specific extraprostatic extension was low (2 of 35 cases or 5.7%). In contrast, the risk of side specific extraprostatic extension was 56.8% (25 of 44 cases) when maximum tumor length was 7 mm or greater and the basal core was positive for cancer.
Applying our criteria for prostatectomy could significantly decrease the risk of inadequate cancer control and increase the probability of maintaining potency in patients with prostate cancer with biopsy Gleason score 8 or greater.
近期数据表明，对于经过恰当选择的患者，高级别前列腺癌是一种潜在可通过手术治愈的疾病。我们评估了术前变量预测活检Gleason评分8分及以上男性患者前列腺外侵犯的能力。
我们确定了159例在1996年至2006年间因活检证实为Gleason评分8分及以上、T1c - T2N0M0癌症而接受前列腺切除术且未接受新辅助治疗的患者。使用包括临床特征和活检结果在内的患侧特异性数据进行单因素和多因素分析，以预测前列腺外侵犯。
159例患者中有84例（52.8%）病理证实为器官局限性癌症。对124侧（124例男性）进行患侧特异性分析可行，其中124侧中有48侧（38.7%）发现患侧特异性前列腺外侵犯。Gleason 5级成分、肿瘤最大长度、阳性活检芯比例、基底活检芯阳性以及患侧可触及病变与患侧特异性前列腺外侵犯显著相关。多因素分析显示，肿瘤最大长度和基底活检芯阳性是患侧特异性前列腺外侵犯的独立预测因素（分别为p <0.001和0.033）。当肿瘤最大长度小于7 mm且基底活检芯无癌时，患侧特异性前列腺外侵犯的发生率较低（3个病例中有2个，即5.7%）。相反，当肿瘤最大长度为7 mm或更长且基底活检芯有癌时，患侧特异性前列腺外侵犯的风险为56.8%（44个病例中有25个）。
应用我们的前列腺切除标准可显著降低癌症控制不足的风险，并提高活检Gleason评分8分及以上前列腺癌患者保持性功能的概率。
