1] Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK [2] Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Br J Cancer. 2014 May 13;110(10):2405-11. doi: 10.1038/bjc.2014.192. Epub 2014 Apr 10.
Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters.
Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed.
Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations.
In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy.
识别患有非显著前列腺癌（PC）的男性对于选择接受主动监测的患者非常重要。已经开发了一些工具，这些工具可以基于临床和活检参数，在 PSA 筛查人群中识别出这类男性。
对 2007 年 7 月至 2011 年 10 月期间在英国一家三级护理中心接受根治性前列腺切除术的 848 例患者进行了前瞻性收集的病例系列研究。肿瘤体积通过病理检查进行评估。对于每种工具，通过三种不同标准预测非显著疾病的接受者操作特征曲线进行计算，并比较每个曲线下的面积。比较了筛查和未筛查人群的准确性。
在 848 例患者中，有 415 例在活检中为 Gleason 3+3 疾病。其中，32.0%有前列腺外延伸，50.2%升级。有 1 例淋巴结阳性。206 例（队列的 24%）为 D'Amico 低危。其中，143 例有超过 2 个活检核心受累。评估的工具均没有足够的预测肿瘤负荷非显著的能力。在 PSA 筛查和未筛查人群中的准确性都较低。
在我们未筛查的人群中，用于识别非显著 PC 的工具是不准确的。未筛查人群中前列腺肿瘤的检测范围更广，可能导致相对不准确。
