Ramakrishnan Venkat M, Bossert Karolin, Singer Gad, Lehmann Kurt, Hefermehl Lukas J
University of Louisville, School of Medicine, Louisville, Kentucky, United States.
Division of Urology, Department of Surgery, Kantonsspital Baden, Switzerland.
Cent European J Urol. 2017;70(4):344-348. doi: 10.5173/ceju.2017.1561. Epub 2017 Oct 20.
Current treatment plans for localized prostate carcinoma (PC) are based on core needle biopsies (CNB) classified using the Gleason score (GS). Recently, many institutions have started using the latest version of International Society of Urological Pathology (ISUP) guideline revision from 2014 for PC grading. Interestingly, this adoption is occurring without first understanding whether the 2005 ISUP revisions had a positive clinical impact. CNB-based GS may underestimate tumor aggressiveness and, therefore, critically impact patient eligibility for active surveillance (AS). The 2005 ISUP recommendations bore a significant impact on the grading of Gleason 6 and 7 PCs - a range that is meaningful for AS. The objective of this study was to compare the concordance between GS in CNB and radical prostatectomy (RP) before and after the 2005 ISUP guideline revisions, with an emphasis on its clinical impact on AS.
This was a single-center, prospective observational study. CNB were performed in a standardized manner. GS of CNB and RP specimens were compared across three time periods: 1999-2005 (pre-revision), 2006-2007 (transitional period), and 2008-2015 (post-revision). AS is usually employed in patients with GS 6 or GS 7 PC. Thus, we therefore focused on the analysis of patients with CNBs of GS ≤7.
Between 1999 and 2015, 380 men with GS ≤7 PC underwent RP at our institution (median age: 62y; median PSA: 5.8 ng/ml). Of these, 231 CNB specimens were classified as GS ≤6, while 149 were GS 7.46% (pre-revision), 43% (transitional), and 54% (post-revision) of CNB with original scores ≤6 were later upgraded in corresponding RP specimens (p <0.001).
The 2005 ISUP GS revisions did not lower the rates of GS upgrades in RP specimens when compared to corresponding initial CNBs. Thus, these revisions did not improve AS selection. Future advances in molecular diagnostics may provide additional valuable information that facilitates patient enrollment in AS programs.
局限性前列腺癌（PC）的当前治疗方案基于使用Gleason评分（GS）分类的核心针吸活检（CNB）。最近，许多机构已开始采用2014年国际泌尿病理学会（ISUP）指南的最新版本对PC进行分级。有趣的是，这种采用在没有首先了解2005年ISUP修订版是否具有积极临床影响的情况下就发生了。基于CNB的GS可能低估肿瘤侵袭性，因此对患者的主动监测（AS）资格产生关键影响。2005年ISUP建议对Gleason 6级和7级PC的分级产生了重大影响——这一范围对AS具有重要意义。本研究的目的是比较2005年ISUP指南修订前后CNB和根治性前列腺切除术（RP）中GS的一致性，重点是其对AS的临床影响。
这是一项单中心前瞻性观察研究。CNB以标准化方式进行。在三个时间段比较CNB和RP标本的GS：1999 - 2005年（修订前）、2006 - 2007年（过渡期）和2008 - 2015年（修订后）。AS通常用于GS 6或GS 7的PC患者。因此，我们重点分析GS≤7的CNB患者。
1999年至2015年期间，380例GS≤7的PC男性在我们机构接受了RP（中位年龄：62岁；中位PSA：5.8 ng/ml）。其中，231例CNB标本分类为GS≤6，149例为GS 7。原始评分≤6的CNB中，46%（修订前）、43%（过渡期）和54%（修订后）在相应的RP标本中后来被升级（p<0.001）。
与相应的初始CNB相比，2005年ISUP GS修订版并未降低RP标本中GS升级的发生率。因此，这些修订并未改善AS选择。分子诊断的未来进展可能提供有助于患者纳入AS计划的额外有价值信息。
