Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Choi Won Suk Urology Clinic, Yongin, Korea.
Prostate Int. 2014 Mar;2(1):37-42. doi: 10.12954/PI.13031. Epub 2014 Mar 30.
A major limitation of performing hemiablative focal therapy (FT) for prostate cancer (PCa) is the possibility of accompanying significant cancer in the contralateral side of the prostate that is missed on prostate biopsy. We attempted to verify whether clinical and biopsy-related parameters can be used to predict the absence of significant cancer in the prostate lobe.
We assumed that hemiablative FT could be performed in patients with low-risk PCa, with unilateral tumors as assessed by transrectal ultrasound-guided biopsy. We evaluated 214 patients who had undergone radical prostatectomy (RP) and fulfilled the eligibility criteria. Seemingly preserved lobes, defined by the absence of cancer on biopsy, were classified as lobes with no cancer (LNC), lobes with insignificant cancer (LIC), and lobes with significant cancer (LSC) according to RP pathology. Cases with an estimated tumor volume of <0.5 mL, a Gleason score of <7, and organ confinement without Gleason pattern 4 were classified as LIC. Univariate and multivariate logistic regression analyses were performed to identify predictors for LSC. Predictive accuracies of the multivariate models were assessed using receiver operating characteristic curve-derived areas under the curve.
Of 214 evaluated lobes, 45 (21.0%), 62, (29.0%), and 107 (50.0%) were classified as LNC, LIC, and LSC, respectively. Among the clinical and biopsy-related parameters, prostate-specific antigen density and prostate volume were identified as significant predictors for LSC in univariate regression analysis. However, multivariate analysis did not identify an independent predictor. Predictive accuracies of the multivariate models did not exceed 70.4%.
Conventional parameters have limited value in predicting LSC in patients who are candidates for hemiablative FT.
行前列腺癌（PCa）半消融焦点治疗（FT）的一个主要局限性在于，经直肠超声引导前列腺活检可能会遗漏对侧前列腺的显著肿瘤。我们试图验证临床和活检相关参数是否可用于预测前列腺叶中是否存在显著肿瘤。
我们假设经直肠超声引导前列腺活检评估为单侧肿瘤的低危 PCa 患者可以行半消融 FT。我们评估了 214 例符合条件的接受根治性前列腺切除术（RP）的患者。根据 RP 病理学，无肿瘤的活检定义为看似保留的叶，分为无肿瘤叶（LNC）、无显著肿瘤叶（LIC）和有显著肿瘤叶（LSC）。肿瘤体积估计<0.5mL、Gleason 评分为<7 分且器官未受侵犯且无 Gleason 模式 4 的病例被归类为 LIC。采用单变量和多变量逻辑回归分析来确定 LSC 的预测因子。采用受试者工作特征曲线下面积评估多变量模型的预测准确性。
在评估的 214 个叶中，45 个（21.0%）、62 个（29.0%）和 107 个（50.0%）分别被归类为 LNC、LIC 和 LSC。在临床和活检相关参数中，前列腺特异性抗原密度和前列腺体积在单变量回归分析中被确定为 LSC 的显著预测因子。然而，多变量分析未确定独立的预测因子。多变量模型的预测准确性未超过 70.4%。
对于候选行半消融 FT 的患者，常规参数对预测 LSC 的价值有限。
