Montanari Emanuele, Del Nero Alberto, Gazzano Giacomo, Mangiarotti Barbara, Bernardini Paolo, Longo Fabrizio, Cordima Giovanni, Itri Emanuele
Department of Urology, San Paolo Hospital, University of Milan, Italy.
Arch Ital Urol Androl. 2009 Mar;81(1):9-12.
To determine if the presence of a single minute neoplastic lesion defined as a lesion < or = 0.5 mm in length and Gleason score < or = 6 at biopsy is a reliable predictor of the presence of a potentially clinically insignificant carcinoma at radical prostatectomy.
We searched in our series of 151 consecutive patients submitted to radical retropubic prostatectomy from September 2003 to April 2007 for patients with a single minute focus of cancer at prostate biopsy. In all bioptic samples we calculated the total length of cores, length and percentage of neoplastic areas and Gleason grade. Total PSA and PSA density was obtained in all patients. Potentially clinically insignificant cancers at radical prostatectomy were defined as those with a tumor volume < or = 0.5 cc, Gleason score < or = 6 and organ confined disease. The clinical and pathological characteristics of patients with minute prostatic lesion were compared with other prostate cancers by using the 2-sample t-test and chi square test.
In 18 (11.9%) patients the prostate biopsy showed a single neoplastic focus of < or = 0.5 mm in length and Gleason score of < or = 6. At definitive histological analysis of the RRP specimen only 5 patients (27.7%) presented a neoplasia potentially clinically insignificant. These patients on the preoperative criteria didn't show any statistically significant difference from the group with clinically significant neoplastic lesion at radical prostatectomy as far as prostate volume, total PSA, PSA density and total length of bioptic core.
The weak correspondence between the presence of neoplastic lesions of minimal entity at prostate biopsy and potentially clinical insignificant carcinoma at radical prostatectomy has also been confirmed by our data: only 30% of patients with a single minute focus of well differentiated prostate cancer at biopsy showed at definitive pathology a potentially clinically insignificant cancer. Moreover the parameters we considered as possible predictive factors of clinically insignificant carcinoma did not demonstrate to be reliable criteria in order to identify these patients.
确定活检时定义为长度≤0.5毫米且Gleason评分≤6的单个微小肿瘤性病变是否是根治性前列腺切除术中潜在临床意义不大的癌存在的可靠预测指标。
在我们2003年9月至2007年4月连续接受根治性耻骨后前列腺切除术的151例患者系列中，寻找前列腺活检时有单个微小癌灶的患者。在所有活检样本中，我们计算了活检组织条的总长度、肿瘤区域的长度和百分比以及Gleason分级。所有患者均测定了总前列腺特异抗原（PSA）和PSA密度。根治性前列腺切除术中潜在临床意义不大的癌定义为肿瘤体积≤0.5立方厘米、Gleason评分≤6且肿瘤局限于器官内的癌。采用两样本t检验和卡方检验，将有微小前列腺病变患者的临床和病理特征与其他前列腺癌患者进行比较。
18例（11.9%）患者的前列腺活检显示有单个长度≤0.5毫米且Gleason评分≤6的肿瘤灶。在对根治性耻骨后前列腺切除术（RRP）标本进行最终组织学分析时，只有5例患者（27.7%）有潜在临床意义不大的肿瘤。就前列腺体积、总PSA、PSA密度和活检组织条总长度而言，这些患者根据术前标准与根治性前列腺切除术中具有临床意义的肿瘤性病变组相比，未显示出任何统计学上的显著差异。
我们的数据也证实了前列腺活检时微小实体肿瘤性病变的存在与根治性前列腺切除术中潜在临床意义不大的癌之间的对应关系较弱：活检时有单个微小分化良好前列腺癌灶的患者中，只有30%在最终病理检查时显示有潜在临床意义不大的癌。此外，我们视为可能的临床意义不大癌的预测因素的参数，并未证明是识别这些患者的可靠标准。
