Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Urology Department, Al Kasr Al Aini Hospital, Cairo University, Giza, Egypt.
Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
J Urol. 2016 Jun;195(6):1767-72. doi: 10.1016/j.juro.2015.12.079. Epub 2015 Dec 24.
We assessed the pathological outcomes after radical prostatectomy in men with favorable risk prostate cancer diagnosed on first/initial biopsy compared to those of men who were diagnosed on a subsequent/repeat prostate biopsy.
We identified 422 patients who met National Comprehensive Cancer Network® very low (199) and low risk (223) prostate cancer definitions who instead underwent radical prostatectomy. In each risk category we compared adverse pathological outcomes, defined as Gleason score upgrading, extraprostatic extension, seminal vesicle invasion and positive surgical margins, between men diagnosed on initial prostate biopsy vs repeat/subsequent prostate biopsy after a negative biopsy(-ies).
There were no significant differences in the baseline clinical and demographic characteristics between the groups. However, men who were diagnosed on initial prostate biopsy demonstrated a higher median maximum cancer percent per single core (p <0.001) and higher median percent of positive cores (p <0.001). Compared to repeat/subsequent prostate biopsy, men diagnosed on initial prostate biopsy had a higher Gleason score upgrade (7 or greater) (57.7% vs 42.1%, p=0.005) and extraprostatic extension (14.1% vs 5.4%, p=0.01). On stratified analysis comparing initial prostate biopsy to repeat/subsequent prostate biopsy, very low risk disease was associated with Gleason score upgrade (49.3% vs 31.8%, p=0.02) and low risk disease demonstrated higher rates of extraprostatic extension (19.9% vs 6.0%, p=0.02).
The likelihood of adverse pathological outcomes at radical prostatectomy is lower in men diagnosed with favorable risk prostate cancer on repeat/subsequent prostate biopsy than in men diagnosed on initial prostate biopsy, and may represent an important consideration in risk stratifying cases of favorable risk prostate cancer.
我们评估了首次/初始前列腺活检诊断为低危前列腺癌的患者与随后/重复前列腺活检诊断为低危前列腺癌的患者行根治性前列腺切除术的病理结局。
我们确定了 422 名符合国家综合癌症网络非常低危（199 名）和低危（223 名）前列腺癌定义的患者，这些患者实际上接受了根治性前列腺切除术。在每个风险类别中，我们比较了初始前列腺活检诊断与重复/随后前列腺活检阴性后的不良病理结局，定义为 Gleason 评分升级、前列腺外延伸、精囊侵犯和阳性切缘。
两组患者的基线临床和人口统计学特征无显著差异。然而，初始前列腺活检诊断的患者单核心中最大癌症百分比中位数更高（p<0.001），阳性核心百分比中位数更高（p<0.001）。与重复/随后的前列腺活检相比，初始前列腺活检诊断的患者 Gleason 评分升级（7 分或更高）的比例更高（57.7%比 42.1%，p=0.005）和前列腺外延伸的比例更高（14.1%比 5.4%，p=0.01）。在比较初始前列腺活检与重复/随后前列腺活检的分层分析中，极低危疾病与 Gleason 评分升级相关（49.3%比 31.8%，p=0.02），低危疾病表现出更高的前列腺外延伸率（19.9%比 6.0%，p=0.02）。
与初始前列腺活检诊断的患者相比，重复/随后前列腺活检诊断为低危前列腺癌的患者行根治性前列腺切除术的不良病理结局的可能性较低，这可能是对低危前列腺癌进行风险分层的一个重要考虑因素。
