Kryvenko Oleksandr N, Epstein Jonathan I
aDepartments of Pathology and Laboratory Medicine, Urology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USAbDepartments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Curr Opin Urol. 2017 May;27(3):191-197. doi: 10.1097/MOU.0000000000000388.
This chapter describes important changes in the clinical practice and pathological interpretation of prostate cancer (PCa) that stratify PCa into insignificant and significant disease to allow for better patient management and treatment decisions.
Among the most important changes over the last half a decade has been the change in PCa grading. A new grading system has been developed that is more patient-centric with more accurate stratification according to risk of disease progression. An additional advance is the recent recommendation to report percentage of pattern 4 in Gleason score 7 cancer that may help identify a subset of these men who have relatively insignificant prostate cancer. The definition of significant PCa at prostatectomy has also been extended from a dichotomized classification into a more tiered nuanced approach. Factors involved in classification of significant cancer at prostatectomy include grade, stage along with classification of extraprostatic extension into focal and nonfocal, and tumor volume. Of these variables, tumor volume appears to be least critical as an independent variable. Promising genetic discoveries may also help predict significant cancer, especially in the small subset of lower-grade cancers.
Significant PCa is a spectrum of findings bearing different clinical significance with some nuanced definitions at biopsy and prostatectomy.
本章描述了前列腺癌（PCa）临床实践和病理解读中的重要变化，这些变化将PCa分为无意义和有意义的疾病，以便更好地管理患者和做出治疗决策。
在过去五年中最重要的变化之一是PCa分级的改变。已经开发出一种新的分级系统，该系统更以患者为中心，根据疾病进展风险进行更准确的分层。另一个进展是最近建议报告Gleason评分7分癌症中4级模式的百分比，这可能有助于识别这些患有相对无意义前列腺癌的男性亚组。前列腺切除术中显著PCa的定义也已从二分法分类扩展为更具层次的细微差别方法。前列腺切除术中显著癌症分类所涉及的因素包括分级、分期以及前列腺外扩展分为局灶性和非局灶性的分类，还有肿瘤体积。在这些变量中，肿瘤体积作为一个独立变量似乎最不重要。有前景的基因发现也可能有助于预测显著癌症，尤其是在低级别癌症的小亚组中。
显著PCa是一系列具有不同临床意义的发现，在活检和前列腺切除术中存在一些细微差别定义。
