Department of Urology, Saint-Louis Hospital, APHP, Paris, France.
Eur Urol. 2011 Aug;60(2):291-303. doi: 10.1016/j.eururo.2011.05.006. Epub 2011 May 17.
The notion of insignificant prostate cancer (Ins-PCa) has progressively emerged in the past two decades. The clinical relevance of such a definition was based on the fact that low-grade, small-volume, and organ-confined prostate cancer (PCa) may be indolent and unlikely to progress to biologic significance in the absence of treatment.
To review the definition of Ins-PCa, its incidence, and the clinical impact of Ins-PCa on the contemporary management of PCa.
A review of the literature was performed using the Medline, Scopus, and Web of Science databases with no restriction on language up to September 2010. The literature search used the following terms: insignificant, indolent, minute, microfocal, minimal, low volume, low risk, and prostate cancer.
The most commonly used criteria to define Ins-PCa are based on the pathologic assessment of the radical prostatectomy specimen: (1) Gleason score ≤ 6 without Gleason pattern 4 or 5, (2) organ-confined disease, and (3) tumour volume<0.5 cm(3). Several preoperative criteria and prognostication tools for predicting Ins-PCa have been suggested. Nomograms are best placed to estimate the risk of progression on an individualised basis, but a substantial proportion of men with a high probability of harbouring Ins-PCa are at risk for pathologic understaging and/or undergrading. Thus, there is an ongoing need for identifying novel and more accurate predictors of Ins-PCa to improve the distinction between insignificant versus significant disease and thus to promote the adequate management of PCa patients at low risk for progression.
The exciting challenge of obtaining the pretreatment diagnostic tools that can really distinguish insignificant from significant PCa should be one of the main objectives of urologists in the following years to decrease the risk of overtreatment of Ins-PCa.
无意义前列腺癌（Ins-PCa）的概念在过去二十年中逐渐出现。这种定义的临床相关性基于以下事实：低级别、小体积和器官局限的前列腺癌（PCa）可能惰性，并且在没有治疗的情况下不太可能进展为生物学意义。
回顾 Ins-PCa 的定义、其发生率以及 Ins-PCa 对当代 PCa 管理的临床影响。
使用 Medline、Scopus 和 Web of Science 数据库进行文献复习，截至 2010 年 9 月，不限制语言。文献检索使用以下术语：无意义、惰性、微小、微灶、最小、低体积、低风险和前列腺癌。
定义 Ins-PCa 最常用的标准基于前列腺切除术标本的病理评估：（1）Gleason 评分≤6 且无 Gleason 模式 4 或 5，（2）器官局限疾病，（3）肿瘤体积<0.5cm(3)。已经提出了几种术前标准和预测 Ins-PCa 的预后工具。列线图最适合基于个体化估计进展风险，但很大一部分患有高概率 Ins-PCa 的男性存在病理分期不足和/或分级不足的风险。因此，需要确定新的和更准确的 Ins-PCa 预测因子，以改善对无意义和有意义疾病的区分，从而促进对进展风险低的 PCa 患者的适当管理。
获得能够真正区分无意义和有意义 PCa 的术前诊断工具的令人兴奋的挑战应该是泌尿科医生在未来几年的主要目标之一，以降低过度治疗 Ins-PCa 的风险。
