Sarici Hasmet, Telli Onur, Yigitbasi Orhan, Ekici Musa, Ozgur Berat Cem, Yuceturk Cem Nedim, Eroglu Muzaffer
Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey;
Department of Urology, Ankara Yıldırım Bayezit Training and Research Hospital, Ankara, Turkey.
Can Urol Assoc J. 2014 May;8(5-6):E342-6. doi: 10.5489/cuaj.1499.
The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option.
We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size.
In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001).
When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.
前列腺穿刺活检与前列腺切除术后Gleason评分之间的差异很常见。我们研究了前列腺穿刺活检特征对于预测接受根治性耻骨后前列腺切除术（RRP）且穿刺活检Gleason评分≤6的患者Gleason评分（GS）升级的预测价值。我们的目的是确定GS升级的预测因素，并为临床医生确定治疗方案提供指导。
我们对2007年1月至2013年3月期间在2个主要中心接受临床局限性前列腺癌RRP的患者进行了一项回顾性研究。所有在筛查时直肠指检异常或前列腺特异性抗原升高的患者均接受经直肠超声引导下前列腺穿刺活检。在有和没有GS升级的患者中评估变量。我们的研究局限性包括其回顾性设计、所有受试者均为土耳其人这一事实以及样本量较小这一事实。
总共有321名男性前列腺穿刺活检的GS≤6。其中，190名（59.2%）的GS≤6一致，131名（40.8%）在前列腺切除时GS从穿刺活检时的≤6升级到7或更高。病理升级的独立预测因素是前列腺体积<40 cc（p<0.001）、任何一个穿刺针芯中癌的最大百分比（p=0.011）以及>1个穿刺针芯癌阳性（p<0.001）。
在采用扩展穿刺针芯活检方案时，前列腺较小（≤40 cc）、>1个穿刺针芯癌阳性以及癌负担增加的患者与GS升级风险增加相关。对于穿刺活检GS≤6且具有这些病理参数的患者，应就治疗决策进行仔细的咨询。
