Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Urology. 2010 Sep;76(3):682-7. doi: 10.1016/j.urology.2009.11.067. Epub 2010 Mar 5.
To determine whether saturation needle biopsy of the prostate (SBx) can accurately predict prostate cancer (PCA) location in radical prostatectomy (RP) specimens. The success of focal therapy for PCA relies on accurate mapping of cancer before the procedure.
A total of 72 patients underwent SBx followed by RP for PCA. The biopsy protocol consisted of traditional sextant, plus additional ≥10 cores. A single pathologist mapped the tumor outline on RP, determined the number of PCA foci, their Gleason score (GS), and stage.
Patients' median age and preoperative serum prostate-specific antigen was 60 years and 5.6 ng/mL, respectively. SBx detected bilateral PCA in 33 and unilateral PCA in 39 men. All cases with bilateral PCA by SBx had bilateral tumor in RP. Only 4 of 39 patients with unilateral positive SBx had unilateral cancer in RP. Twelve potentially clinically significant PCA were missed by SBx in 11 of 35 patients: 2 were GS6 and 10 GS7; 11 were stage pT2 and 1 pT3. When patients with unilateral and bilateral positive SBx were compared with respect to prognostic parameters, biopsy GS (P = .004), number of biopsy cores involved (P <.0001), and highest percentage of core (P = .0005) involved by tumor were significantly higher for patients with bilateral positive biopsy.
Most (90%) patients with unilateral PCA on SBx had bilateral cancer in RP; of those 31% had clinically significant undiagnosed PCA. A negative SBx does not confirm the absence of cancer in the corresponding side of the gland and cannot be used as single determinant when considering a patient for focal treatment.
确定前列腺饱和度穿刺活检（SBx）是否能准确预测前列腺癌（PCA）在根治性前列腺切除术（RP）标本中的位置。PCA 局灶治疗的成功依赖于术前对癌症的准确定位。
共 72 例 PCA 患者行 SBx 后行 RP。活检方案包括传统的 6 区法，外加至少 10 个核心。一位病理学家在 RP 上绘制肿瘤轮廓，确定 PCA 病灶数量、其 Gleason 评分（GS）和分期。
患者的中位年龄和术前前列腺特异性抗原分别为 60 岁和 5.6ng/mL。SBx 检测到 33 例双侧 PCA 和 39 例单侧 PCA。所有双侧 SBx 阳性的病例在 RP 中均有双侧肿瘤。仅 39 例单侧 SBx 阳性的患者中有 4 例在 RP 中单侧癌症。11 例 35 例有潜在临床意义的 PCA 在 SBx 中漏诊：2 例 GS6，10 例 GS7；11 例 pT2 期，1 例 pT3 期。在比较单侧和双侧 SBx 阳性患者的预后参数时，活检 GS（P=0.004）、活检涉及的核心数量（P<0.0001）和肿瘤累及的最高核心百分比（P=0.0005）在双侧 SBx 阳性的患者中显著更高。
大多数（90%）SBx 单侧 PCA 的患者在 RP 中存在双侧癌症；其中 31%存在未诊断的临床意义重大的 PCA。阴性的 SBx 并不能确定腺体对应侧不存在癌症，在考虑患者进行局灶治疗时不能作为单一决定因素。
