Laboratory of Surgical and Molecular Pathology, Sao Paulo, Brazil.
Urol Oncol. 2012 Nov-Dec;30(6):794-7. doi: 10.1016/j.urolonc.2010.10.010. Epub 2011 Apr 1.
Because of the improvements on detection of early stage prostate cancer over the last decade, focal therapy for localized prostate cancer (PC) has been proposed for patients with low-risk disease. Such treatment would allow the control of cancer, thereby diminishing side effects, such as urinary incontinence and sexual dysfunction, which have an enormous impact on quality of life. The critical issue is whether it is possible to preoperatively predict clinically significant unifocal or unilateral prostate cancer with sufficient accuracy. Our aim is to determine whether there is any preoperative feature that can help select the ideal patient for focal therapy.
A total of 599 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy followed by radical prostatectomy to treat PC were examined in our laboratory between 2001 and 2009. We established very restricted criteria to select patients with very-low-risk disease for whom focal therapy would be suitable (only 1 biopsy core positive, tumor no larger than 80% of a single core, no perineural invasion, PSA serum level < 10 ng/ml, Gleason score < 7 and clinical stage T1c, T2a-b). We defined 2 groups of patients who would be either adequately treated or not treated by focal therapy. The primary endpoint was the evaluation of preoperative features in order to identify which parameters should be considered when choosing good candidates for focal therapy.
Fifty-six out of 599 patients met our criteria. The mean age was 59 years, and the mean number of biopsy cores was 14.4. Forty-seven (83.9%) were staged T1c, and 9 (16.1%) were staged T2a-b. Forty-four (78.6%) patients could be considered to have been adequately treated by focal therapy, and 12 (21.4%) could not. There was no statistical difference between the 2 groups considering age, clinical stage, PSA levels, Gleason score, and tumor volume in the biopsy. All 12 patients who could be considered inadequately treated had a bilateral, significant secondary tumor, 58.3% had Gleason ≥ 7, and 25% were staged pT3.
Although focal therapy might be a good option for patients with localized prostate cancer, we are so far unable to select which of them would benefit from it based on preoperative data, even using very restricted criteria, and a considerable proportion of men would still be left undertreated.
由于过去十年中早期前列腺癌检测水平的提高，针对局限性前列腺癌（PC）的局部治疗（即聚焦治疗）已被提议用于低危疾病患者。这种治疗方法可以控制癌症，从而减少尿失禁和性功能障碍等副作用，这些副作用对生活质量有巨大影响。关键问题是是否有可能术前准确预测具有临床意义的单灶或单侧前列腺癌。我们的目的是确定是否存在任何术前特征可以帮助选择适合聚焦治疗的理想患者。
2001 年至 2009 年，我们在实验室中对 599 名接受经直肠超声（TRUS）引导的前列腺活检后行根治性前列腺切除术治疗 PC 的患者进行了检查。我们建立了非常严格的标准来选择非常低危疾病患者，这些患者适合聚焦治疗（只有 1 个活检核心阳性，肿瘤不超过 1 个核心的 80%，无神经周围侵犯，血清 PSA<10ng/ml，Gleason 评分<7，临床分期 T1c，T2a-b）。我们定义了 2 组患者，一组通过聚焦治疗充分治疗，另一组不治疗。主要终点是评估术前特征，以确定在选择聚焦治疗的合适候选者时应考虑哪些参数。
599 名患者中有 56 名符合我们的标准。平均年龄为 59 岁，平均活检核心数为 14.4 个。47 名（83.9%）分期为 T1c，9 名（16.1%）分期为 T2a-b。44 名（78.6%）患者可通过聚焦治疗充分治疗，12 名（21.4%）患者不能。考虑年龄、临床分期、PSA 水平、Gleason 评分和活检中的肿瘤体积，两组之间无统计学差异。12 名治疗不足的患者均为双侧、显著的次要肿瘤，58.3%的患者 Gleason 评分≥7，25%的患者分期为 pT3。
尽管聚焦治疗可能是局限性前列腺癌患者的一个很好的选择，但即使使用非常严格的标准，我们目前仍无法根据术前数据选择哪些患者将从中受益，仍有相当一部分男性得不到充分治疗。
