Good Daniel W, Stewart Grant D, Zakikhani Paimaun, Yuen Henry, Riddick Antony C P, Bollina Prasad R, O'Donnell Marie, Stolzenburg Jens-Uwe, McNeill S Alan
Edinburgh Urological Cancer Group, University of Edinburgh, Crewe Road South, Edinburgh, EH2 4XU, UK,
World J Urol. 2014 Apr;32(2):393-8. doi: 10.1007/s00345-013-1114-3. Epub 2013 Jun 13.
The purpose of the study is to characterise the clinicopathological characteristics of anterior prostate cancer (APC) compared to posterior prostate cancer (PPC)s and to determine the midterm oncological outcomes of patients with APCs undergoing endoscopic extraperitoneal radical prostatectomy (EERPE).
A retrospective review was carried out on all EERPEs performed in 2009. Pathology reports (transrectal ultrasound biopsy and surgical specimen), specimen photographs, demographic details and oncological outcome data from a prospectively maintained database were reviewed. Unpaired t test, chi-squared test and Kaplan-Meier curves were used for the analysis.
Of 139 patients identified, 53 were APCs (38 %) and 86 were PPCs (62 %). Significantly, greater number of repeat biopsies were required to diagnose APCs (p = 0.02) and they had significantly fewer positive biopsy cores (p = 0.0005). The APC group had a significantly higher PSA density (PSAd) with (<5 and 5-25 %) tumour involvement in positive cores compared to PPCs (p = 0.036 and 0.024, respectively). APCs had higher positive surgical margin (PSM) rates (p = ns), the apical margin more likely positive than PPCs (p = 0.0006). Biochemical recurrence-free survival (BRFS) for APCs at 1, 2 and 3 years was lower than PPCs, although not statistically significant (p = 0.16).
In our study, APCs proved more difficult to diagnose and stage, had a higher PSM rate and a trend towards a worse bRFS than PPCs. Additionally, the use of PSAd low core involvement biopsies might aide clinicians to investigate this cohort of patients more thoroughly before advising active surveillance.
本研究旨在描述前列腺前癌（APC）相较于前列腺后癌（PPC）的临床病理特征，并确定接受内镜下腹膜外根治性前列腺切除术（EERPE）的APC患者的中期肿瘤学结局。
对2009年进行的所有EERPE手术进行回顾性分析。回顾了病理报告（经直肠超声活检和手术标本）、标本照片、人口统计学细节以及来自前瞻性维护数据库的肿瘤学结局数据。采用非配对t检验、卡方检验和Kaplan-Meier曲线进行分析。
在139例确诊患者中，53例为APC（38%），86例为PPC（62%）。值得注意的是，诊断APC需要更多的重复活检（p = 0.02），且其阳性活检核心显著更少（p = 0.0005）。与PPC相比，APC组的前列腺特异抗原密度（PSAd）显著更高，且阳性核心中肿瘤累及率分别为（<5%和5%-25%）（分别为p = 0.036和0.024）。APC的阳性手术切缘（PSM）率更高（p = 无统计学意义），尖部切缘比PPC更易呈阳性（p = 0.0006）。APC在1年、2年和3年的无生化复发生存率（BRFS）低于PPC，尽管无统计学意义（p = 0.16）。
在我们的研究中，APC比PPC更难诊断和分期，PSM率更高，且bRFS有更差的趋势。此外，使用PSAd低核心累及活检可能有助于临床医生在建议积极监测之前更全面地评估这组患者。
