Khang In Ho, Kim Yun Beom, Yang Seung Ok, Lee Jeong Ki, Jung Tae Young
Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
Korean J Urol. 2012 Aug;53(8):531-5. doi: 10.4111/kju.2012.53.8.531. Epub 2012 Aug 16.
We evaluated the differences in pathological outcomes between prostate cancers (PCas) diagnosed at initial and repeat biopsy.
We retrospectively reviewed the medical records of 287 patients who underwent radical retropubic prostatectomy from 2005 to 2010. We investigated preoperative factors, such as age, serum prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) results, biopsy schema, clinical stage, and number of prior biopsies, and postoperative pathological outcomes, including specimen volume, percent tumor volume, Gleason score (GS), tumor bilaterality, pathological stage, positive surgical margin (PSM), lymphovascular invasion (LVI), and perineural invasion (PNI). Patients were then classified into two groups by the number of prior biopsies (initial biopsy vs. repeat biopsy). We compared preoperative factors and postoperative pathological outcomes between the two groups.
Of the 287 patients, 246 (85.7%) were diagnosed with cancer at the initial biopsy and 41 (14.3%) at the repeat biopsy. The repeat biopsy group was older (p=0.048), had a larger PV (p=0.009), had a significantly different biopsy schema (p<0.001), and had a lower (<10%) percentage tumor volume (p=0.016). In the multivariate analysis (after adjustment for biopsy schema, age, serum PSA, PV, and DRE), repeat biopsy was not an independent predictor of GS, tumor bilaterality, pathological stage, PSM, LVI, or PNI (p=0.212, 0.456, 0.459, 0.917, 0.991 and 0.827, respectively), but repeat biopsy could predict lower percentage tumor volume (p=0.037).
The pathological outcomes of PCas detected at repeat biopsy were not significantly different from those of PCas detected at initial biopsy except for a lower (<10%) percentage tumor volume.
我们评估了初次活检和重复活检诊断的前列腺癌（PCa）在病理结果上的差异。
我们回顾性分析了2005年至2010年期间接受耻骨后根治性前列腺切除术的287例患者的病历。我们调查了术前因素，如年龄、血清前列腺特异性抗原（PSA）、前列腺体积（PV）、直肠指检（DRE）结果、活检方案、临床分期以及既往活检次数，以及术后病理结果，包括标本体积、肿瘤体积百分比、 Gleason评分（GS）、肿瘤双侧性、病理分期、手术切缘阳性（PSM）、淋巴管侵犯（LVI）和神经周围侵犯（PNI）。然后根据既往活检次数将患者分为两组（初次活检组与重复活检组）。我们比较了两组之间的术前因素和术后病理结果。
在287例患者中，246例（85.7%）在初次活检时被诊断为癌症，41例（14.3%）在重复活检时被诊断为癌症。重复活检组年龄更大（p=0.048），PV更大（p=0.009），活检方案有显著差异（p<0.001），肿瘤体积百分比更低（<10%）（p=0.016）。在多变量分析中（在调整活检方案、年龄、血清PSA、PV和DRE后），重复活检不是GS、肿瘤双侧性、病理分期、PSM、LVI或PNI的独立预测因素（p分别为0.212、0.456、0.459、0.917、0.991和0.827），但重复活检可预测更低的肿瘤体积百分比（p=0.037）。
除肿瘤体积百分比更低（<10%）外，重复活检检测到的PCa的病理结果与初次活检检测到的PCa的病理结果无显著差异。
