Pourmand Gholamreza, Gooran Shahram, Hossieni Seyed Reza, Guitynavard Fateme, Safavi Majid, Sharifi Amirsina, Mokhtari Ehsan
Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2017 Apr;55(4):249-253.
Preoperative Gleason score (GS) obtained from Trans Rectal Ultra Sonography (TRUS) is the most common grading system to evaluate the appropriate treatment for patients with clinically localized prostate cancer. But this method showed upgraded and downgraded results in comparison to Gleason score obtained from radical prostatectomy. The current study aimed to determine clinical or pathological variables to reduce the differences between biopsy and radical prostatectomy Gleason scores.Through retrospective review of 52 patients with radical prostatectomy, this study examined the correlations of preoperative Gleason score with age, prostate volume, PSA level, PSA density, digital rectal exam findings and percentage of positive core needle biopsies across two groups, including patients with preoperative GS≤6 (i.e. group one) and patients with preoperative GS≥7 (group two). The discordance between biopsy GS and radical prostatectomy GS was observed to be 52% in the current study. Among patients with preoperative GS≤6, prostate volume (P=0.026), PSA density (P=0.032) and percentage of positive core needle biopsies (P=0.042) were found to be significant predictors for upgrade. There was no significant predictor for downgrade in patients with preoperative GS≥7. Findings of this study revealed that in patients with preoperative GS≤6, smaller prostate volume, higher prostate density and higher positive results of core needle biopsies were associated with theupgrade of GS. Therefore, it should be considered when selecting treatment modalities among these patients.
经直肠超声检查（TRUS）获得的术前Gleason评分（GS）是评估临床局限性前列腺癌患者合适治疗方案最常用的分级系统。但与根治性前列腺切除术后获得的Gleason评分相比，这种方法显示出评分升高和降低的结果。本研究旨在确定临床或病理变量，以减少活检和根治性前列腺切除术Gleason评分之间的差异。通过对52例行根治性前列腺切除术患者的回顾性研究，本研究考察了术前Gleason评分与年龄、前列腺体积、前列腺特异性抗原（PSA）水平、PSA密度、直肠指检结果以及两组患者穿刺活检阳性核心组织百分比之间的相关性，这两组患者分别为术前GS≤6的患者（即第一组）和术前GS≥7的患者（第二组）。在本研究中，活检GS与根治性前列腺切除术GS之间的不一致率为52%。在术前GS≤6的患者中，前列腺体积（P = 0.026）、PSA密度（P = 0.032）和穿刺活检阳性核心组织百分比（P = 0.042）被发现是评分升高的显著预测因素。在术前GS≥7的患者中，没有发现评分降低的显著预测因素。本研究结果显示对于术前GS≤6的患者，较小的前列腺体积、较高的前列腺密度和较高的穿刺活检阳性结果与GS升高相关。因此，在这些患者中选择治疗方式时应予以考虑。
