Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
J Urol. 2010 Oct;184(4):1328-33. doi: 10.1016/j.juro.2010.06.017. Epub 2010 Aug 17.
Limited information is available on radical prostatectomy findings in men with intraductal carcinoma of the prostate on needle core biopsy in the absence of invasive prostate cancer.
From the consulting files of one of us we identified 83 men in whom biopsy showed only intraductal prostate cancer. Followup was available in 66 cases. We reviewed slides in 21 radical prostatectomy cases.
Treatment was radical prostatectomy in 23 men, radiation therapy in 15, hormone therapy in 8 and radiation plus hormone therapy in 15 while 5 underwent no treatment or repeat biopsy. Of the 21 radical prostatectomies available for review findings revealed pathological stage pT3a in 8 (38%), pT3b in 3 (13%), pT2 in 8 (38%) and intraductal carcinoma without identifiable invasive cancer in 2 (10%). One patient with pT3a had a positive lymph node at surgery. Average Gleason score was 7.9. Three patients (14%) experienced post-prostatectomy biochemical failure and another (5%) had bone metastases 2.5 years after prostatectomy. In 15 prostatectomies (71%) there was extensive intraductal carcinoma, defined as greater than 10% of tumor being intraductal, including the 2 cases of intraductal carcinoma only. Of the 19 prostatectomies with invasive adenocarcinoma 16 (84%) were conventional acinar adenocarcinoma, 2 (11%) ductal adenocarcinoma, and 1 (5%) mixed ductal and acinar adenocarcinoma.
At radical prostatectomy men in whom prior biopsies showed only intraductal carcinoma of the prostate typically have high grade (Gleason score 7 or greater) invasive adenocarcinoma and most have advanced stage disease (pT3). Definitive therapy is recommended in men with intraductal carcinoma of the prostate on needle biopsy even in the absence of pathologically documented invasive prostate cancer.
在没有浸润性前列腺癌的情况下，对于经针芯活检显示仅为前列腺导管内癌的男性，有关根治性前列腺切除术的发现信息有限。
从我们的咨询档案中，我们确定了 83 名活检仅显示前列腺导管内癌的男性。66 例可获得随访。我们复习了 21 例根治性前列腺切除术的切片。
23 例接受根治性前列腺切除术治疗，15 例接受放疗，8 例接受激素治疗，15 例接受放疗加激素治疗，而 5 例未接受治疗或重复活检。在可用于审查的 21 例根治性前列腺切除术中，发现病理分期 pT3a 为 8 例（38%），pT3b 为 3 例（13%），pT2 为 8 例（38%），2 例（10%）为无明确浸润性癌的导管内癌。1 例 pT3a 患者在手术时发现淋巴结阳性。平均 Gleason 评分为 7.9。3 例（14%）患者在前列腺切除术后发生生化失败，另 1 例（5%）患者在前列腺切除术后 2.5 年发生骨转移。在 15 例前列腺切除术（71%）中，有广泛的导管内癌，定义为大于 10%的肿瘤为导管内癌，包括仅导管内癌的 2 例。在 19 例有浸润性腺癌的前列腺切除术中，16 例（84%）为常规的腺泡性腺癌，2 例（11%）为导管腺癌，1 例（5%）为混合导管和腺泡性腺癌。
在根治性前列腺切除术时，对于之前活检仅显示前列腺导管内癌的男性，通常具有高级别（Gleason 评分 7 或更高）浸润性腺癌，且大多数具有晚期疾病（pT3）。即使在没有病理证实的浸润性前列腺癌的情况下，对于经针芯活检显示前列腺导管内癌的男性，也推荐进行确定性治疗。
