Department of Urology, VitaSalute University, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Prostate. 2012 Jun 1;72(8):925-30. doi: 10.1002/pros.21497. Epub 2011 Sep 30.
The aim of this study was to assess the clinical characteristics of the potentially ideal candidates for focal therapy, that is, patients with unilateral, small volume (namely, pT2a) prostate cancer (PCa) at radical prostatectomy (RP).
We evaluated 2,503 consecutive pT2 PCa patients treated with RP between 2002 and 2009 at a single center. Within this population, the clinical characteristics of patients with pT2a and pT2b/c disease were compared. Univariable and multivariable logistic regression models were fitted to assess clinical predictors of pT2a at RP.
Overall, 349 patients (14%) had pT2a PCa, while the remaining patients had either pT2b (n = 334; 15.5%) or pT2c disease (n = 1,820 patients; 84.5%). Patients with pT2a PCa had a significantly lower mean PSA value, lower mean percentage of positive biopsy cores and lower biopsy Gleason score distribution (all P ≤ 0.03). However, at multivariable analyses, only percentage of positive cores maintained an independent predictor status (P = 0.01). Even when considering only patients sharing all the most favorable PCa characteristics (namely, clinical stage T1, PSA ≤ 4, Gleason score ≤6 and percentage of positive cores ≤25%), the rate of pT2a disease was only 24%.
The rate of small volume, unilateral PCa even among patients with extremely favourable PCa characteristics was remarkably low (roughly 25%). This suggests that: (1) Three quarters of the best candidates for focal therapy would ultimately show adverse pathological features; (2) At present, accurate identification of the ideal candidate for focal therapy is not possible with current clinical-pathologic parameters.
本研究旨在评估潜在适合局灶性治疗的患者的临床特征，即根治性前列腺切除术（RP）中单侧、小体积（即 pT2a）前列腺癌（PCa）患者。
我们评估了 2002 年至 2009 年在单中心接受 RP 治疗的 2503 例连续 pT2 PCa 患者。在该人群中，比较了 pT2a 和 pT2b/c 疾病患者的临床特征。使用单变量和多变量逻辑回归模型来评估 RP 时 pT2a 的临床预测因素。
总体而言，349 例（14%）患者患有 pT2a PCa，而其余患者患有 pT2b（n=334；15.5%）或 pT2c 疾病（n=1820 例；84.5%）。pT2a PCa 患者的平均 PSA 值、平均阳性活检核心百分比和活检 Gleason 评分分布均显著较低（均 P≤0.03）。然而，在多变量分析中，只有阳性核心百分比保留独立预测地位（P=0.01）。即使仅考虑具有所有最有利的 PCa 特征（即临床分期 T1、PSA≤4、Gleason 评分≤6 和阳性核心百分比≤25%）的患者，pT2a 疾病的发生率也仅为 24%。
即使在具有非常有利的 PCa 特征的患者中，小体积、单侧 PCa 的发生率也非常低（约 25%）。这表明：（1）在局灶性治疗的最佳候选者中，有四分之三最终会出现不良的病理特征；（2）目前，通过当前的临床病理参数，无法准确识别局灶性治疗的理想候选者。
