Department of Urology, University of Mainz, Germany.
BJU Int. 2012 Jan;109(2):214-9. doi: 10.1111/j.1464-410X.2011.10187.x. Epub 2011 May 18.
To evaluate clinical predictors for Gleason score upgrade (GSU) in radical prostatectomy (RP) specimen, especially in patients with 'very' low risk PCA (T1c and biopsy Gleason score ≤6 and PSA <10 ng/ml and ≤2 positive biopsy cores and PSA density <0.15).
402 consecutive patients undergoing RP between 2004 and 2006, including a subgroup of 62 patients with 'very' low risk PCA, were examined. Patients were categorized for clinically relevant GSU (defined as upgrade into a higher PCA risk category). Parameters including number of biopsy cores obtained, positive biopsy cores, prostate weight, PSA, DRE and pathology department were evaluated for their role as predictors. Furthermore, GSU in RP specimen was analyzed for its impact on pT-stage.
Clinically relevant GSU occurred in 38.1% in the whole cohort and in 32.3% in the 'very' low risk PCA subgroup. Gleason score downgrade (GSD) occurred in 4.7%. Number of biopsy cores obtained and prostate weight were independent negative predictors of GSU in all 402 patients (P = 0.02 and P = 0.03, respectively). In the 'very' low risk group, only number of biopsy cores obtained revealed as an independent negative predictor of GSU (P = 0.02). PSA, DRE, number of positive cores or pathology department were not associated to GSU. In the 'very' low risk group, GSU was related with extracapsular tumor extension (P = 0.05).
Clinically relevant GSU in RP specimen is still a challenging problem. Increasing the number of biopsy cores lower this risk significantly. GSD is rare and thus of minor importance for treatment decisions.
评估根治性前列腺切除术（RP）标本中 Gleason 评分升级（GSU）的临床预测因素，特别是在“非常”低危前列腺癌（T1c 和活检 Gleason 评分≤6，PSA<10ng/ml 和≤2 个阳性活检核心和 PSA 密度<0.15）患者中。
对 2004 年至 2006 年间接受 RP 的 402 例连续患者进行了检查，其中包括 62 例“非常”低危前列腺癌患者的亚组。患者被分为具有临床相关 GSU（定义为升级为更高的前列腺癌风险类别）的类别。评估了包括获得的活检核心数量、阳性活检核心、前列腺重量、PSA、DRE 和病理科等参数作为预测因素的作用。此外，还分析了 RP 标本中的 GSU 对 pT 期的影响。
整个队列中临床相关 GSU 发生率为 38.1%，“非常”低危前列腺癌亚组为 32.3%。GSU 发生率为 38.1%，GSD 发生率为 4.7%。在所有 402 例患者中，获得的活检核心数量和前列腺重量是 GSU 的独立负预测因素（P=0.02 和 P=0.03）。在“非常”低危组中，只有获得的活检核心数量是 GSU 的独立负预测因素（P=0.02）。PSA、DRE、阳性核心数量或病理科与 GSU 无关。在“非常”低危组中，GSU 与包膜外肿瘤延伸有关（P=0.05）。
RP 标本中的临床相关 GSU 仍然是一个具有挑战性的问题。增加活检核心数量可显著降低这种风险。GSD 很少见，因此对治疗决策的重要性较小。
