Wong Lih-Ming, Tang Vincent, Peters Justin, Costello Anthony, Corcoran Niall
The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia.
Department of Urology, St. Vincent's Hospital Melbourne, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia.
BJU Int. 2016 Apr;117 Suppl 4:82-7. doi: 10.1111/bju.13460.
To examine the feasibility of active surveillance for low volume Gleason sum (GS) 3 + 4 disease compared to GS 3 + 3 disease.
Retrospective review of 929 patients, with biopsy proven GS 3 + 3 and 3 + 4 PCa, undergoing upfront radical prostatectomy (RP) was performed. Suitability for AS was adapted from protocols by Royal Marsden Hospital, University of Toronto, and PRIAS by allowing Gleason 3 + 4 disease. The outcomes assessed were adverse pathology at RP (upgrading ≥GS 4 + 3 and/or upstaging ≥pT3) and biochemical recurrence (BCR) after RP.
Adverse pathology at RP was compared between GS 3 + 3 vs 3 + 4 groups. When selecting patients using Royal Marsden (n = 714) or University of Toronto (n = 699) protocols, there was statistically significantly more adverse pathology at RP in GS 3 + 4 group (21% vs 31%, P = 0.0028 and 19% vs 33%, P=<0.001 respectively). Using the more stringent PRIAS protocol (n = 198), there was no statistical significant difference in groups. There was no difference in BCR survival between biopsy GS 3 + 3 and 3 + 4 groups, regardless of which AS protocol assessed. Pre-operative PSA and clinical staging were the predictors for BCR.
Presence of Gleason 3 + 4 at biopsy, when compared to 3 + 3, increases the risk of adverse pathology being present at radical prostatectomy for less stringent selection criteria. When considering AS, a stricter protocol such as PRIAS, limiting PSA density and number of positive cores to ≤2, appears to decrease the risk of adverse pathology. No differences in BCR were seen between biopsy 3 + 3 and 3 + 4 disease, regardless of AS selection criteria.
探讨与Gleason评分3+3疾病相比，对低体积Gleason总分（GS）3+4疾病进行主动监测的可行性。
对929例经活检证实为GS 3+3和3+4前列腺癌（PCa）且接受 upfront根治性前列腺切除术（RP）的患者进行回顾性研究。根据皇家马斯登医院、多伦多大学的方案以及PRIAS方案，调整了主动监测的适用性，纳入了Gleason评分3+4疾病。评估的结局指标为RP时的不良病理结果（升级至≥GS 4+3和/或分期至≥pT3）以及RP后的生化复发（BCR）。
比较了GS 3+3组和3+4组在RP时的不良病理结果。使用皇家马斯登医院方案（n = 714）或多伦多大学方案（n = 699）选择患者时，GS 3+4组在RP时出现不良病理结果的比例在统计学上显著更高（分别为21%对31%，P = 0.0028；19%对33%，P < 0.001）。使用更严格的PRIAS方案（n = 198）时，两组之间无统计学显著差异。无论采用哪种主动监测方案评估，活检GS 3+3组和3+4组之间的BCR生存率均无差异。术前PSA和临床分期是BCR的预测因素。
与Gleason评分3+3相比，活检时存在Gleason评分3+4会增加在根治性前列腺切除术中出现不良病理结果的风险，尤其是在选择标准不太严格的情况下。在考虑主动监测时，采用更严格的方案，如PRIAS，将PSA密度和阳性核心数量限制在≤2，似乎可以降低出现不良病理结果的风险。无论主动监测选择标准如何，活检3+3和3+4疾病之间的BCR无差异。
