Department of Urology, University of Tuebingen, Tuebingen, Germany.
Prostate Cancer Prostatic Dis. 2010 Jun;13(2):182-5. doi: 10.1038/pcan.2009.54. Epub 2009 Dec 22.
When offering watchful waiting or active monitoring protocols to prostate cancer (PCa) patients, differentiation between Gleason scores (GS) 6 and 7 at biopsy is important. However, upgrading after prostatectomy is common. We investigated the impact of different PSA levels on misclassification in the PSA range of 2-3.9 and 4-10 ng ml(-1). A total of 448 patients with GS 6 PCa on prostate biopsy were evaluated by comparing biopsy and prostatectomy GS. Possible over diagnosis was defined as GS <7, pathological stage pT2a and negative surgical margins, and possible under diagnosis was defined as pT3a or greater, or positive surgical margins; the percentage of over- or under diagnosis was determined for correctly and upgraded tumors after prostatectomy. A match between biopsy and prostatectomy GS was found in 210 patients (46.9%). Patients in the PSA range of 2.0-3.9 and 4.0-10.0 ng ml(-1) were upgraded in 32.6 and 44.0%, respectively. Over diagnosis was more common than under diagnosis (23.2% vs 15.6%). When upgraded there was a significant increase in under diagnosis. As almost 40% of GS 6 tumors on biopsy are GS 7 or higher after surgery with a significant rise in under diagnosis there is a risk of misclassification and subsequent delayed or even insufficient treatment, when relying on favorable biopsy GS.
在为前列腺癌 (PCa) 患者提供观察等待或主动监测方案时，区分活检时的 Gleason 评分 (GS) 6 和 7 非常重要。然而，前列腺切除术后升级的情况很常见。我们研究了不同 PSA 水平对 2-3.9 和 4-10ng/ml PSA 范围内误诊的影响。通过比较前列腺活检和前列腺切除术的 GS，对 448 名 GS 6 前列腺癌患者进行评估。可能过度诊断定义为 GS<7、病理分期 pT2a 和阴性切缘，可能漏诊定义为 pT3a 或更高、或阳性切缘；确定正确诊断和升级肿瘤在前列腺切除术后的过度或漏诊百分比。在 210 名患者（46.9%）中发现了活检和前列腺切除术 GS 的匹配。在 PSA 范围为 2.0-3.9 和 4.0-10.0ng/ml 的患者中，分别有 32.6%和 44.0%升级。过度诊断比漏诊更常见（23.2%比 15.6%）。升级时，漏诊显著增加。由于几乎 40%的活检 GS 6 肿瘤在手术后为 GS 7 或更高，并且漏诊显著增加，因此，当依赖有利的活检 GS 时，存在误诊和随后延迟或甚至治疗不足的风险。
