James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland.
J Urol. 2013 Dec;190(6):2033-8. doi: 10.1016/j.juro.2013.05.015. Epub 2013 May 13.
At our institution the eligibility criteria used to enroll patients in active surveillance are clinical stage T1, prostate specific antigen density less than 0.15 ng/ml, biopsy Gleason score 6 or less, 2 or fewer positive biopsy cores and 50% or less involvement of any biopsy core. We hypothesized that these criteria may be excessively strict, precluding many men from active surveillance.
We studied pathological outcomes in men treated with radical prostatectomy between 1995 and 2012 who met 4 or more of the 5 active surveillance criteria. Outcomes included a definition of significant tumor (pathological Gleason 7 or greater, or nonorgan confined). We compared adverse pathology rates between men who met all 5 vs 4 of 5 active surveillance criteria.
Of 8,261 men 1,890 (22.9%) met all active surveillance eligibility criteria and 2,133 (25.8%) met 4. Men with values exceeding prostate specific antigen density and biopsy Gleason criteria were at increased risk for adverse pathological outcomes. Clinical stage greater than T1 was not associated with adverse pathological findings. The risk of significant tumors in men with clinical stage T2 lesions, 3 or fewer positive biopsy cores and less than 60% core involvement was comparable to that of men who met all active surveillance criteria.
Prostate specific antigen density greater than 0.15 ng/ml and biopsy Gleason score 7 or greater are strongly associated with adverse pathological findings at radical prostatectomy. Our findings suggest that active surveillance criteria should be expanded to include men with clinical stage T2 lesions and a greater number of positive biopsy cores of low grade. Based on these preliminary findings, we are in the process of reassessing active surveillance eligibility criteria using more detailed pathological analysis.
在我们的机构中，用于招募患者进行主动监测的入选标准为临床分期 T1、前列腺特异性抗原密度小于 0.15ng/ml、活检 Gleason 评分为 6 分或更低、2 个或更少的阳性活检核心以及任何活检核心的 50%或更少的受累。我们假设这些标准可能过于严格，使许多男性无法接受主动监测。
我们研究了 1995 年至 2012 年间接受根治性前列腺切除术治疗的符合 4 项或 5 项主动监测标准中的 4 项或更多项标准的男性的病理结果。结果包括定义为显著肿瘤（病理 Gleason 7 或更高，或非器官受限）。我们比较了符合所有 5 项与符合 4 项主动监测标准的男性之间的不良病理率。
在 8261 名男性中，有 1890 名（22.9%）符合所有主动监测入选标准，2133 名（25.8%）符合 4 项标准。前列腺特异性抗原密度和活检 Gleason 标准值超过的男性患不良病理结果的风险增加。临床分期大于 T1 与不良病理发现无关。临床分期 T2 病变、3 个或更少的阳性活检核心和小于 60%的核心受累男性的显著肿瘤风险与符合所有主动监测标准的男性相当。
前列腺特异性抗原密度大于 0.15ng/ml 和活检 Gleason 评分 7 或更高与根治性前列腺切除术后的不良病理发现密切相关。我们的发现表明，主动监测标准应扩大到包括临床分期 T2 病变和更多低级别阳性活检核心的男性。基于这些初步发现，我们正在使用更详细的病理分析重新评估主动监测入选标准。
