Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Urology. 2012 Oct;80(4):883-8. doi: 10.1016/j.urology.2012.05.045. Epub 2012 Aug 22.
To identify parameters that predict insignificant prostate cancer in 67 radical prostatectomies after biopsy reclassification to worse disease on active surveillance.
Parameters evaluated at diagnosis and at biopsy reclassification included serum prostate-specific antigen, prostate-specific antigen density, number of positive cores, maximum percent involvement of cancer per core, and any interval negative biopsies. Gleason upgrading at biopsy reclassification was also assessed to predict insignificant cancer.
Mean time between diagnosis and radical prostatectomies was 30.3 months with a median of 3 biopsies (range 2-9). Nineteen of 67 (28.4%) had clinically insignificant cancer at radical prostatectomy. In the entire group, there were no variables significantly associated with insignificant cancer at radical prostatectomy. In a subgroup analysis of 37 patients without Gleason pattern 4/5 at biopsy reclassification, 16/37 (43.2%) showed insignificant cancer at radical prostatectomy. In this subgroup, prostate-specific antigen at diagnosis was significantly lower in men with insignificant cancer (3.7 ng/mL) vs significant cancer (5.4 ng/mL) (P = .0005). With prostate-specific antigen <4 ng/mL at diagnosis or at biopsy reclassification, 12/13 (92.3%) men showed insignificant cancer, whereas only 4/24 (16.7%) men with prostate-specific antigen >4 ng/mL both at diagnosis and at biopsy reclassification showed insignificant cancer.
Most men with biopsy reclassification while on active surveillance have significant disease at radical prostatectomy, justifying their treatment. Low prostate-specific antigen at diagnosis or at biopsy reclassification can predict a high probability of insignificant cancer in the absence of Gleason pattern 4/5 on biopsy. These men may be candidates for continuing active surveillance.
在对主动监测中活检重新分类为更差疾病的 67 例根治性前列腺切除术患者中，确定预测前列腺癌不显著的参数。
在诊断时和活检重新分类时评估的参数包括血清前列腺特异性抗原、前列腺特异性抗原密度、阳性核心数、每个核心癌症受累的最大百分比以及任何间隔阴性活检。还评估了活检重新分类时的 Gleason 升级以预测不显著的癌症。
诊断和根治性前列腺切除术之间的平均时间为 30.3 个月，中位数为 3 次活检（范围 2-9）。67 例中有 19 例（28.4%）在根治性前列腺切除术中患有临床不显著的癌症。在整个组中，没有变量与根治性前列腺切除术中的不显著癌症显著相关。在没有活检重新分类时出现 Gleason 模式 4/5 的 37 例患者的亚组分析中，16/37（43.2%）在根治性前列腺切除术中显示不显著的癌症。在这个亚组中，诊断时前列腺特异性抗原在患有不显著癌症的男性中显著低于患有显著癌症的男性（3.7 ng/mL）与（5.4 ng/mL）（P =.0005）。在诊断时或活检重新分类时前列腺特异性抗原<4 ng/mL，13/13（92.3%）男性表现为不显著的癌症，而在诊断时和活检重新分类时前列腺特异性抗原>4 ng/mL 的 24/24（16.7%）男性中仅 4/4 表现为不显著的癌症。
在主动监测中活检重新分类的大多数男性在根治性前列腺切除术中存在显著疾病，这证明他们的治疗是合理的。在没有活检上出现 Gleason 模式 4/5 的情况下，诊断时或活检重新分类时的低前列腺特异性抗原可以预测出现不显著癌症的可能性较高。这些男性可能是继续进行主动监测的候选者。
