Edwan Ghazi Al, Ghai Sangeet, Margel David, Kulkarni Girish, Hamilton Rob, Toi Ants, Haidar Masoom A, Finelli Antonio, Fleshner Neil E
Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON.
Can Urol Assoc J. 2015 May-Jun;9(5-6):E267-72. doi: 10.5489/cuaj.2562.
Clinical confusion continues to exist regarding the underestimation of cancers among patients on active surveillance and among men with repeated negative prostate biopsies despite worrisome prostate-specific antigen (PSA) levels. We have previously described our initial experience with magnetic resonance imaging (MRI)-based detection of tumours in the anterior prostate gland. In this report, we update and expand our experience with these tumours in terms of multiparametric-MRI findings, staging, and grading. Furthermore, we report early treatment outcomes with these unique cancers.
We reviewed our prostate MRI dataset of 1117 cases from January 2006 until December 2012 and identified 189 patients who fulfilled criteria for prostate evasive anterior tumors (PEATS). Descriptive analyses were performed on multiple covariates. Kaplan-Meier actuarial technique was used to plot the treatment-related outcomes from PEATS tumours.
Among the 189 patients who had MRI-detectable anterior tumours, 148 had biopsy proven disease in the anterior zone. Among these tumours, the average PSA was 18.3 ng/mL and most cancers were Gleason 7. In total, 68 patients chose surgical therapy. Among these men, most of their cancers had extra prostatic extension and 46% had positive surgical margins. Interestingly, upgrading of tumours that were biopsy Gleason 6 in the anterior zone was common, with 59% exhibiting upgrading to Gleason 7 or higher. Biochemical-free survival among men who elected surgery was not ideal, with 20% failing by 20 months.
PEATS tumours are found late and are disproportionally high grade tumours. Careful consideration to MRI testing should be given to men at risk for PEATS.
对于接受主动监测的患者以及前列腺特异性抗原（PSA）水平令人担忧但多次前列腺活检结果均为阴性的男性，癌症被低估的情况在临床上仍然存在混淆。我们之前已经描述了基于磁共振成像（MRI）检测前列腺前叶肿瘤的初步经验。在本报告中，我们从多参数MRI表现、分期和分级方面更新并扩展了我们对这些肿瘤的经验。此外，我们报告了这些独特癌症的早期治疗结果。
我们回顾了2006年1月至2012年12月期间1117例患者的前列腺MRI数据集，确定了189例符合前列腺隐匿性前叶肿瘤（PEATS）标准的患者。对多个协变量进行了描述性分析。采用Kaplan-Meier精算技术绘制PEATS肿瘤的治疗相关结果。
在189例MRI可检测到前叶肿瘤的患者中，148例经活检证实前叶有病变。在这些肿瘤中，平均PSA为18.3 ng/mL，大多数癌症为Gleason 7级。共有68例患者选择了手术治疗。在这些男性中，他们的大多数癌症都有前列腺外侵犯，46%的患者手术切缘阳性。有趣的是，前叶活检为Gleason 6级的肿瘤常见升级情况，59%的肿瘤升级为Gleason 7级或更高。选择手术的男性患者的无生化复发生存情况并不理想，20%的患者在20个月时出现复发。
PEATS肿瘤发现较晚，且多为高分级肿瘤。对于有PEATS风险的男性，应仔细考虑进行MRI检查。
