Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):784-7. doi: 10.1016/j.ijrobp.2009.05.068. Epub 2009 Oct 26.
Hemiablative therapy (HAT) is increasing in popularity for treatment of patients with low-risk prostate cancer (PCa). The validity of this therapeutic modality, which exclusively treats PCa within a single prostate lobe, rests on accurate staging. We tested the accuracy of unilaterally unremarkable biopsy findings in cases of low-risk PCa patients who are potential candidates for HAT.
The study population consisted of 243 men with clinical stage <or=T2a, a prostate-specific antigen (PSA) concentration of <10 ng/ml, a biopsy-proven Gleason sum of <or=6, and a maximum of 2 ipsilateral positive biopsy results out of 10 or more cores. All men underwent a radical prostatectomy, and pathology stage was used as the gold standard. Univariable and multivariable logistic regression models were tested for significant predictors of unilateral, organ-confined PCa. These predictors consisted of PSA, % fPSA (defined as the quotient of free [uncomplexed] PSA divided by the total PSA), clinical stage (T2a vs. T1c), gland volume, and number of positive biopsy cores (2 vs. 1).
Despite unilateral stage at biopsy, bilateral or even non-organ-confined PCa was reported in 64% of all patients. In multivariable analyses, no variable could clearly and independently predict the presence of unilateral PCa. This was reflected in an overall accuracy of 58% (95% confidence interval, 50.6-65.8%).
Two-thirds of patients with unilateral low-risk PCa, confirmed by clinical stage and biopsy findings, have bilateral or non-organ-confined PCa at radical prostatectomy. This alarming finding questions the safety and validity of HAT.
对于低危前列腺癌（PCa）患者，半消融治疗（HAT）的应用日益增多。这种专门治疗单个前列腺叶内 PCa 的治疗方式的有效性依赖于准确的分期。我们在可能适合 HAT 的低危 PCa 患者中，检验了单侧无显著异常的活检结果的准确性。
研究人群包括 243 名临床分期<T2a、前列腺特异抗原（PSA）浓度<10ng/ml、活检证实的 Gleason 评分总和<6、10 针以上的活检中最多 2 针同侧阳性的患者。所有患者均接受根治性前列腺切除术，以病理分期作为金标准。采用单变量和多变量逻辑回归模型检验单侧、器官局限型 PCa 的显著预测因子。这些预测因子包括 PSA、%fPSA（定义为游离[未结合]PSA 与总 PSA 的商）、临床分期（T2a 与 T1c）、腺体体积和阳性活检针数（2 针与 1 针）。
尽管在活检时为单侧分期，但仍有 64%的患者报告为双侧或甚至非器官局限型 PCa。在多变量分析中，没有单一变量能明确且独立地预测单侧 PCa 的存在。这反映出总体准确率为 58%（95%置信区间，50.6%-65.8%）。
经临床分期和活检证实为单侧低危 PCa 的患者中，有三分之二在根治性前列腺切除术后存在双侧或非器官局限型 PCa。这一令人震惊的发现对 HAT 的安全性和有效性提出了质疑。
