The Brady Institute of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Urol. 2014 Jan;191(1):60-7. doi: 10.1016/j.juro.2013.06.021. Epub 2013 Jun 14.
Of men with very low risk prostate cancer at biopsy recent evidence shows that black American men are at greater risk for adverse oncologic outcomes after radical prostatectomy. We studied radical prostatectomy specimens from black and white men at very low risk to determine whether there are systematic pathological differences.
Radical prostatectomy specimens were evaluated in men with National Comprehensive Cancer Network® (NCCN) very low risk prostate cancer. At diagnosis all men underwent extended biopsy sampling (10 or more cores) and were treated in the modern Gleason grade era. We analyzed tumor volume, grade and location in 87 black and 89 white men. For each specimen the dominant nodule was defined as the largest tumor with the highest grade.
Compared to white men, black men were more likely to have significant prostate cancer (61% vs 29%), Gleason 7 or greater (37% vs 11%, each p <0.001) and a volume of greater than 0.5 cm(3) (45% vs 21%, p = 0.001). Dominant nodules in black men were larger (median 0.28 vs 0.13 cm(3), p = 0.002) and more often anterior (51% vs 29%, p = 0.003). In men who underwent pathological upgrading the dominant nodule was also more frequently anterior in black than in white men (59% vs 0%, p = 0.001).
Black men with very low risk prostate cancer at diagnosis have a significantly higher prevalence of anterior cancer foci that are of higher grade and larger volume. Enhanced imaging or anterior zone sampling may detect these significant anterior tumors, improving the outcome in black men considering active surveillance.
近期有证据表明，在接受根治性前列腺切除术的极低风险前列腺癌患者中，美国黑人男性的肿瘤不良预后风险更高。我们研究了极低风险前列腺癌的黑人和白人男性的根治性前列腺切除术标本，以确定是否存在系统性病理差异。
对符合国家综合癌症网络（NCCN）极低危前列腺癌标准的男性进行根治性前列腺切除术标本评估。所有患者在诊断时均接受了扩展活检（10 个或更多核心），并在现代 Gleason 分级时代接受治疗。我们分析了 87 名黑人男性和 89 名白人男性的肿瘤体积、分级和位置。对于每个标本，优势结节定义为最大肿瘤中分级最高的肿瘤。
与白人男性相比，黑人男性更有可能患有显著前列腺癌（61% vs 29%）、Gleason 7 级或更高（37% vs 11%，均 p <0.001）以及体积大于 0.5 cm(3)（45% vs 21%，p = 0.001）。黑人男性的优势结节更大（中位数 0.28 vs 0.13 cm(3)，p = 0.002），更常位于前位（51% vs 29%，p = 0.003）。在接受病理升级的男性中，黑人男性的优势结节也更常位于前位（59% vs 0%，p = 0.001）。
黑人男性在诊断时患有极低危前列腺癌，其前位癌症灶的患病率明显更高，且肿瘤分级更高、体积更大。增强成像或前区采样可能会检测到这些重要的前位肿瘤，从而改善考虑主动监测的黑人男性的预后。
