Division of Uro-Oncology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
Int Braz J Urol. 2013 Nov-Dec;39(6):800-7. doi: 10.1590/S1677-5538.IBJU.2013.06.05.
Single positive core in a prostate biopsy is usually associated with indolent prostate cancer (PCa) and is one of the active surveillance (AS) inclusion criteria. We investigated whether single positive core PCa at biopsy could define an archetype of low-risk disease.
A total of 1320 consecutive patients were enrolled. Among them, 249 patients with single positive core PCa were followed up, and the clinical and pathological parameters influencing prognosis were analyzed.
Out of the 249 patients, 172 (69.0%) had pathological findings ≥ pT2c and 87 (34.9%) had an undergraded Gleason Score (GS) based on the biopsy. Positive surgical margins (PSMs), extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were found in 20.8%, 10.0% and 6.0% of patients, respectively. In a comparative analysis, we found that the PSA level, prostate weight and number of cores at biopsy are essential to correctly predict an indolent PCa. A total of 125 patients (67.3%) with nonpalpable tumors became high-risk tumors (pT2c-T3). Analyzing only nonpalpable tumors with a GS of 6 at biopsy (156 patients), we noted that 106 (67.9% of cT1) progressed from cT1c to pT2c-pT3.
Single core PCa have clinically significant disease in the Radical Prostatectomy specimens, with considerable rates of overgrading for the GS, pT2c-pT3, PSMs, EPE and SVI. The treatment plan must be evaluated individually for patients with single core PCa and must take into account other prognostic factors when determining whether a patient should be managed with AS.
前列腺活检中单个阳性核心通常与惰性前列腺癌（PCa）相关，是主动监测（AS）纳入标准之一。我们研究了活检中单个阳性核心 PCa 是否可以定义为低风险疾病的典型代表。
共纳入 1320 例连续患者。其中，249 例患者为单个阳性核心 PCa，对影响预后的临床和病理参数进行了分析。
在 249 例患者中，172 例（69.0%）有病理发现≥pT2c，87 例（34.9%）根据活检有未分级的 Gleason 评分（GS）。阳性切缘（PSM）、前列腺外侵犯（EPE）和精囊侵犯（SVI）分别在 20.8%、10.0%和 6.0%的患者中发现。在对比分析中，我们发现 PSA 水平、前列腺重量和活检核心数是正确预测惰性 PCa 的关键因素。共有 125 例（67.3%）无触诊肿瘤患者成为高危肿瘤（pT2c-T3）。仅分析活检时 GS 为 6 且无触诊的肿瘤（156 例），我们发现 106 例（cT1 的 67.9%）从 cT1c 进展为 pT2c-pT3。
单个核心 PCa 在根治性前列腺切除标本中具有显著的临床意义，GS、pT2c-pT3、PSM、EPE 和 SVI 的过度分级率较高。对于单个核心 PCa 患者的治疗方案必须进行个体化评估，在确定患者是否应接受 AS 管理时，必须考虑其他预后因素。
