Ahn Hong Jae, Ko Young Hwii, Jang Hoon Ah, Kang Sung Gu, Kang Seok Ho, Park Hong Seok, Lee Jeong Gu, Kim Je Jong, Cheon Jun
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Korean J Urol. 2010 Oct;51(10):671-6. doi: 10.4111/kju.2010.51.10.671. Epub 2010 Oct 21.
The incidence of single positive core prostate cancer at the time of biopsy appears to be increasing in the prostate-specific antigen (PSA) era. To determine the clinical implication of this disease, we analyzed surgical and pathological characteristics in comparison with multiple positive core disease.
Among 108 consecutive patients who underwent robotic radical prostatectomy following a diagnosis of prostate cancer based on a 12-core transrectal biopsy performed by the same method in a single institute, outcomes from 26 patients (Group 1) diagnosed on the basis of a single positive biopsy core and from 82 patients (Group 2) with multiple positive biopsy cores were analyzed.
The preoperative PSA value, Gleason score, prostate volume, and D'Amico's risk classification of each group were similar. The proportion of intermediate+highrisk patients was 69.2% in Group 1 and 77.9% in Group 2 (p=0.22). Total operative time and blood loss were similar. Based on prostatectomy specimens, only 3 patients (11.5%) in Group 1 met the criteria for an indolent tumor (7.31% in Group 2). Although similarities were observed during preoperative clinical staging (p=0.13), the final pathologic stage was significantly higher in Group 2 (p=0.001). The positive-margin rate was also higher in Group 2 (11.5% vs. 31.7%, p=0.043). Despite similarity in upstaging after prostatectomy in each group (p=0.86), upgrading occurred more frequently in Group 1 (p=0.014, 42.5% vs. 19.5%). No clinical parameters were valuable in predicting upgrading.
Most single positive core prostate cancer diagnoses in 12-core biopsy were clinically significant with similar risk stratification to multiple positive core prostate cancers. Although the positive-margin rate was lower than in multiple positive core disease, an increase in Gleason score after radical prostatectomy occurred more frequently.
在前列腺特异性抗原（PSA）时代，活检时单阳性核心前列腺癌的发病率似乎在上升。为了确定这种疾病的临床意义，我们分析了其手术和病理特征，并与多阳性核心疾病进行比较。
在一家机构中，对108例经直肠12针穿刺活检诊断为前列腺癌后接受机器人根治性前列腺切除术的连续患者进行研究，分析了26例（第1组）基于单阳性活检核心诊断的患者和82例（第2组）多阳性活检核心患者的结果。
两组患者的术前PSA值、Gleason评分、前列腺体积和达米科风险分类相似。第1组中高危患者的比例为69.2%，第2组为77.9%（p=0.22）。总手术时间和失血量相似。根据前列腺切除标本，第1组中只有3例患者（11.5%）符合惰性肿瘤标准（第2组为7.31%）。虽然术前临床分期相似（p=0.13），但第2组的最终病理分期明显更高（p=0.001）。第2组的切缘阳性率也更高（11.5%对31.7%，p=0.043）。尽管两组前列腺切除术后分期上调相似（p=0.86），但第1组中分级上调更频繁（p=0.014，42.5%对19.5%）。没有临床参数对预测分级上调有价值。
12针活检中大多数单阳性核心前列腺癌诊断具有临床意义，风险分层与多阳性核心前列腺癌相似。虽然切缘阳性率低于多阳性核心疾病，但根治性前列腺切除术后Gleason评分增加更频繁。
