Broe M P, Forde J C, Inder M S, Galvin D J, Mulvin D W, Quinlan D M
Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
Ir J Med Sci. 2017 Aug;186(3):583-588. doi: 10.1007/s11845-017-1583-2. Epub 2017 Mar 9.
Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP).
A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4 + 3 versus G3 + 4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage.
In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4 + 3 and 97 graded G3 + 4). Since the introduction of RAPC the proportion of G4 + 3 compared to G3 + 4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4 + 3 treated before and after the introduction of RAPC. G4 + 3 was associated with higher rates of BCR (24.4 vs. 0%, p < 0.0001, radiotherapy (41.1 vs. 4.8%, p < 0.0001) and worse histological features than G3 + 4.
Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4 + 3 disease.
爱尔兰国家癌症控制计划引入了快速通道前列腺诊所（RAPC），从而加快了转诊流程并提高了前列腺癌的检出率。此前已有报道称，RAPC使前列腺癌诊断时的Gleason（G）分级降低，但尚未对前列腺切除时的分级进行评估。本研究的目的是评估RAPC对接受根治性前列腺切除术（RP）的G7期疾病患者手术结果的影响。
对9年期间（2006 - 2014年）进行的所有RP手术进行回顾性分析。比较了RAPC引入前后G7前列腺切除术的结果，并对G4 + 3和G3 + 4进行了进一步的亚组分析。主要结局是生化复发（BCR）。其他结局包括辅助/挽救性放疗、前列腺外侵犯、手术切缘阳性、精囊受累和肿瘤分期。
总共进行了240例RP手术，其中167例为G7分级（70例为G4 + 3分级，97例为G3 + 4分级）。自引入RAPC以来，G4 + 3与G3 + 4的比例从37.9%增加到了42%。引入RAPC前后接受治疗的G4 + 3患者的手术结果无统计学差异。G4 + 3与更高的BCR发生率（24.4%对0%，p < 0.0001）、放疗率（41.1%对4.8%，p < 0.0001）相关，并且组织学特征比G3 + 4更差。
尽管爱尔兰的RAPC在前列腺癌诊断方面带来了益处，但这并未转化为手术治疗患者更低的分级。手术结果尤其是G4 + 3高级别疾病的结果没有改善。
