Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
BJU Int. 2010 Mar;105(6):776-81. doi: 10.1111/j.1464-410X.2009.08957.x. Epub 2009 Oct 26.
Since the widespread of prostate-specific antigen-based screening, prostate cancer at clinical stage T4 has become rare. Most bladder invasion is actually detected on radical prostatectomy specimens as a microscopic bladder neck involvement (BNI). The 2002 Tumour-Node-Metastasis (TNM) classification system classified prostate cancer with BNI within a unified pT4 category and rendered it equivalent to invasion into the pelvic wall musculature or external sphincter; this decision is controversial. Various series have assessed the clinical relevance and the effect of BNI on prognosis. This evidence-based review provides evidence that BNI should be assigned within the subset of pT3 stage, and that further improvement of the actual TNM staging system should be considered. However, BNI remains strongly associated with adverse pathology and should be regarded as a factor that worsens the prognosis of the underlying tumour stage.
自从基于前列腺特异性抗原的筛查广泛应用以来，临床上 T4 期前列腺癌已变得罕见。大多数膀胱侵犯实际上是在根治性前列腺切除术中作为显微镜下的膀胱颈部受累（BNI）被发现的。2002 年的肿瘤-淋巴结-转移（TNM）分类系统将 BNI 内的前列腺癌分类为统一的 pT4 类别，并将其等同于侵犯骨盆壁肌肉或外括约肌；这一决定存在争议。各种系列评估了 BNI 的临床相关性和对预后的影响。这一基于证据的综述提供的证据表明，应该在 pT3 分期的亚组中分配 BNI，并且应该考虑进一步改进实际的 TNM 分期系统。然而，BNI 仍然与不良的病理密切相关，应该被视为恶化潜在肿瘤分期预后的一个因素。
