Division of Surgery and Interventional Science, Centre for Medical Imaging Computing, University College London, Department of Histopathology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.
J Urol. 2011 Aug;186(2):458-64. doi: 10.1016/j.juro.2011.03.147. Epub 2011 Jun 15.
Definitions of prostate cancer risk are limited since accurate attribution of the cancer grade and burden is not possible due to the random and systematic errors associated with transrectal ultrasound guided biopsy. Transperineal prostate mapping biopsy may have a role in accurate risk stratification. We defined the transperineal prostate mapping biopsy characteristics of clinically significant disease.
A 3-dimensional model of each gland and individual cancer was reconstructed using 107 radical whole mount specimens. We performed 500 transperineal prostate mapping simulations per case by varying needle targeting errors to calculate sensitivity, specificity, and negative and positive predictive value to detect lesions 0.2 ml or greater, or 0.5 ml or greater. Definitions of clinically significant cancer based on a combination of Gleason grade and cancer burden (cancer core length) were derived.
Mean±SD patient age was 61±6.4 years (range 44 to 74) and mean prostate specific antigen was 9.7±5.9 ng/ml (range 0.8 to 36.2). We reconstructed 665 foci. The total cancer core length from all positive biopsies for a particular lesion that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 10 mm or greater and 6 mm or greater, respectively. The maximum cancer core length that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 6 mm or greater and 4 mm or greater, respectively. We combined these cancer burden thresholds with dominant and nondominant Gleason pattern 4 to derive 2 definitions of clinically significant disease.
Transperineal prostate mapping may provide an effective method to risk stratify men with localized prostate cancer. The definitions that we present require prospective validation.
由于经直肠超声引导活检存在随机和系统误差，无法准确确定前列腺癌的分级和负担，因此对前列腺癌风险的定义有限。经会阴前列腺图谱活检可能在准确的风险分层中有一定作用。我们定义了经会阴前列腺图谱活检中临床显著疾病的特征。
使用 107 个根治性全距标本，对每个腺体和单个肿瘤进行三维重建。对每个病例进行 500 次经会阴前列腺图谱模拟，通过改变针靶向误差来计算检测 0.2ml 或更大、0.5ml 或更大病变的敏感性、特异性、阴性和阳性预测值。根据 Gleason 分级和肿瘤负荷（肿瘤核心长度）的组合，得出临床显著肿瘤的定义。
患者年龄的平均值±标准差为 61±6.4 岁（范围 44 至 74 岁），前列腺特异性抗原平均值±标准差为 9.7±5.9ng/ml（范围 0.8 至 36.2ng/ml）。我们重建了 665 个病灶。对于检测到 95%以上 0.5ml 或更大、0.2ml 或更大病变的特定病变的所有阳性活检中，总肿瘤核心长度分别为 10mm 或更长和 6mm 或更长。分别检测到 95%以上 0.5ml 或更大和 0.2ml 或更大病变的最大肿瘤核心长度分别为 6mm 或更长和 4mm 或更长。我们将这些肿瘤负荷阈值与主要和次要的 Gleason 模式 4 相结合，得出了两种临床显著疾病的定义。
经会阴前列腺图谱可能为局灶性前列腺癌患者提供一种有效的风险分层方法。我们提出的这些定义需要前瞻性验证。
