Department of Urology, San Raffaele Hospital, Università Vita-Salute, Milan, Italy.
BJU Int. 2011 Aug;108(3):366-71. doi: 10.1111/j.1464-410X.2010.09876.x. Epub 2010 Nov 19.
• To evaluate the accuracy of an initial 24-core prostate biopsy scheme (PBx24) in predicting unilateral prostate cancer (PCa) in radical prostatectomy (RP) specimens.
• Between 2005 and 2008, 203 consecutive patients underwent PBx24 followed by RP for PCa. The area under the curve (AUC) was used to evaluate the accuracy of unilateral PCa on PBx24 to predict unilateral PCa in RP specimens. • The positive predictive value (PPV) and negative predictive value (NPV) were also calculated. Moreover, in patients with unilateral PCa on biopsy, univariable and multivariable logistic regression analyses tested the relationship between the presence of unilateral PCa in an RP specimen and the variables: age, prostate-specific antigen (PSA), total prostate volume, clinical stage, primary Gleason grade, secondary Gleason grade and the number of positive cores.
• PCa cores were unilateral in 115 patients (56.7%) on biopsy. Of those, only 26 (22.6%) had unilateral PCa in the RP specimen (AUC, 72.9%; PPV, 22.6%; NPV, 98.8%). In patients with clinically low-risk tumours, only 17 of 63 (27%) had a unilateral PCa on PBx24 and in the RP specimen (AUC, 59.1%; PPV, 27.0%; NPV, 100.0%). • None of the examined variables was an independent predictor of the presence of unilateral PCa in the RP specimen (all P > 0.05).
• Initial PBx24 is not sufficiently accurate to be dependable as a method of predicting tumour laterality in RP specimens. Therefore, the use of PBx24 to guide hemi-ablation therapy of PCa may lead to mistreatment in a considerable proportion of patients. • Moreover, none of the routinely available clinical and pathological characteristics appears to improve the ability of unilateral PCa on biopsy to predict unilateral PCa in the RP specimen.
评估初始 24 核前列腺活检方案（PBx24）在预测根治性前列腺切除术（RP）标本中单侧前列腺癌（PCa）的准确性。
2005 年至 2008 年间，203 例连续患者接受 PBx24 加 RP 治疗 PCa。使用曲线下面积（AUC）评估 PBx24 上单侧 PCa 预测 RP 标本中单侧 PCa 的准确性。还计算了阳性预测值（PPV）和阴性预测值（NPV）。此外，在活检中存在单侧 PCa 的患者中，单变量和多变量逻辑回归分析测试了 RP 标本中单侧 PCa 的存在与变量之间的关系：年龄、前列腺特异性抗原（PSA）、前列腺总体积、临床分期、原发性 Gleason 分级、次要 Gleason 分级和阳性核心数量。
活检中 115 例（56.7%）患者的 PCa 核心为单侧。其中，仅 26 例（22.6%）在 RP 标本中存在单侧 PCa（AUC，72.9%；PPV，22.6%；NPV，98.8%）。在临床低危肿瘤患者中，63 例中仅有 17 例（27%）在 PBx24 和 RP 标本中存在单侧 PCa（AUC，59.1%；PPV，27.0%；NPV，100.0%）。
检查的变量均不是 RP 标本中单侧 PCa 的独立预测因素（均 P>0.05）。
初始 PBx24 不够准确，不能作为预测 RP 标本中肿瘤侧别的可靠方法。因此，使用 PBx24 指导 PCa 的半切除治疗可能会导致相当一部分患者受到错误治疗。此外，常规临床和病理特征均不能提高活检中单侧 PCa 预测 RP 标本中单侧 PCa 的能力。
