Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
BJU Int. 2010 Aug;106(3):330-3. doi: 10.1111/j.1464-410X.2009.09110.x. Epub 2009 Dec 11.
To describe the histological findings and prognosis that are associated with extraprostatic extension (EPE) on needle core biopsy of prostatic adenocarcinoma.
We retrieved 99 cases of prostatic adenocarcinoma with EPE at initial diagnosis on biopsy from the consultation files of one of the authors between 1997 and 2009. The 72 cases that had available clinical follow-up data formed the basis of this study.
The mean (range) age of the patients was 64 (48-87) years, the median (mean, range) serum prostatic specific antigen level was 7.8 (64.8, 0.3-1505) ng/mL, and 60 of the patients (83%) had abnormalities on a digital rectal examination. The mean (range) number of malignant cores was 7.7 (1-23); the mean percentage of carcinoma in each core was 69.6%, and that in the core(s) with EPE was 76.8%. The mean Gleason score in the core(s) with EPE was 8, with a mean highest Gleason score per case of 8.4. Perineural invasion was detected in 54 cases (75%). Ten of 11 patients treated surgically had EPE on the radical prostatectomy (RP) specimen; also six had positive resection margins, five showed invasion into the seminal vesicles and one had lymph node metastasis. The Gleason scores in nine of the RP specimens did not differ from the highest grade found in the associated biopsies (score 9 in three, 8 in two, 7 in four); in one case it increased (from score 6 to 8) and in one it decreased (from score 9 to 8). Patients were followed for a mean (median, range) of 2.9 (2, 0.1-9) years, with metastases identified in 29 (40%); 10 (14%) died from the disease.
EPE on needle core biopsy of the prostate is strongly associated with extensive, high-grade prostatic adenocarcinoma, such that its usefulness as an isolated prognostic factor is relatively limited.
描述与前列腺腺癌针芯活检中前列腺外延伸（EPE）相关的组织学发现和预后。
我们从作者之一的咨询文件中检索了 1997 年至 2009 年间初次诊断为前列腺腺癌并伴有 EPE 的 99 例病例。有可用临床随访数据的 72 例病例构成了本研究的基础。
患者的平均（范围）年龄为 64（48-87）岁，中位（均值，范围）血清前列腺特异性抗原水平为 7.8（64.8，0.3-1505）ng/mL，60 例患者（83%）直肠指检异常。恶性核心的平均（范围）数量为 7.7（1-23）；每个核心中癌的平均百分比为 69.6%，EPE 核心中的癌百分比为 76.8%。EPE 核心中的平均 Gleason 评分为 8，每个病例的平均最高 Gleason 评分为 8.4。54 例（75%）检测到神经周围侵犯。11 例接受手术治疗的患者中有 10 例在根治性前列腺切除（RP）标本中发现 EPE；同样，6 例有阳性切缘，5 例侵犯精囊，1 例有淋巴结转移。9 例 RP 标本中的 Gleason 评分与相关活检中发现的最高等级（3 例评分 9，2 例评分 8，4 例评分 7）无差异；在 1 例中增加（从评分 6 增加到 8），在 1 例中降低（从评分 9 降低到 8）。患者的平均（中位数，范围）随访时间为 2.9（中位数，0.1-9）年，有 29 例（40%）发现转移；10 例（14%）死于该疾病。
前列腺针芯活检中的 EPE 与广泛的高级别前列腺腺癌密切相关，因此其作为孤立的预后因素的作用相对有限。
