Moon Seung Jin, Park Sung Yul, Lee Tchun Yong
Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
Korean J Urol. 2010 Oct;51(10):677-82. doi: 10.4111/kju.2010.51.10.677. Epub 2010 Oct 21.
The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy.
We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage.
Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS.
If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.
Gleason评分（GS）是前列腺癌诊断及其预后判断时的重要考量因素。然而，经直肠超声（TRUS）引导下穿刺活检与根治性前列腺切除术后GS可能会出现上调。本研究分析了与TRUS活检时相比，根治性前列腺切除术后GS上调的临床预测因素。
我们分析了107例行根治性前列腺切除术患者的病历。患者分为两组。第1组为GS未上调的患者，第2组为GS上调的患者。分析术前临床因素与GS上调之间的关联。术前临床因素包括年龄、前列腺特异性抗原（PSA）、前列腺体积、PSA密度、TRUS活检的GS、癌灶最大核心百分比、阳性核心百分比、活检次数、GS最高的阳性核心位置、高级别前列腺上皮内瘤变（HGPIN）、活检时的炎症以及临床分期。
85例患者中，42例（49%）术后GS上调。TRUS活检核心数为12个或更少（p=0.029）以及前列腺体积为36.5ml或更小（p<0.001）与GS上调相关。与GS未上调相关的术前临床因素为TRUS检查时在尖部（p=0.002）或低回声病灶（p=0.002）发现GS最高的阳性核心。
如果TRUS检查中GS最高的阳性核心位于尖部或低回声病灶处，我们可以预期GS不会上调。对于具有前列腺体积为36.5ml或更小以及TRUS活检核心数少于12个这些临床预测因素的患者，我们可以预期根治性前列腺切除术后GS会上调，可能需要更积极的治疗。
