Freitas D M O, Andriole G L, Castro-Santamaria R, Freedland S J, Moreira D M
a Department of Urology , Nossa Senhora da Conceição Hospital , Porto Alegre , Brazil.
b Division of Urologic Surgery , Washington University School of Medicine , St. Louis , M.O. , U.S.A.
Scand J Urol. 2018 Oct-Dec;52(5-6):328-332. doi: 10.1080/21681805.2018.1551244. Epub 2019 Feb 14.
To evaluate whether the presence of prostate atrophy (P.A.) in negative prostate biopsy is associated with prostate cancer (P.C.a) grade at surgical pathology among men who are ultimately diagnosed with P.C.a and undergo radical prostatectomy (R.P.).
A retrospective analysis was performed of 136 men from the placebo arm of the Reduction by Dutasteride of P.C.a Events (R.E.D.U.C.E.) trial who had a baseline prostate biopsy negative for P.C.a, and were later diagnosed with P.C.a on biopsy and underwent radical prostatectomy over the 4-year study period. The association of baseline P.A. (present/absent) with P.C.a grade (W.H.O./I.S.U.P. grade group 1 or ≥2) at surgical pathology was evaluated with logistic regression in uni- and multivariable analyses, controlling for baseline patient characteristics.
P.A. was observed in 74 prostate biopsies (54%). P.A. was not associated with baseline characteristics (age, body mass index, prostate-specific antigen level, prostate volume, race, family history of P.C.a, and digital rectal exam), except for chronic inflammation (p = 0.001). The presence of P.A. in baseline prostate biopsies was associated with lower risk of W.H.O./I.S.U.P. grade group ≥2 P.C.a in R.P. specimens on both univariable (O.R. = 0.39, 95% C.I. = 0.19-0.78, p = 0.008) and multivariable (O.R. = 0.43, 95% C.I. = 0.20-0.92, p = 0.029) analyses.
Among men with a baseline prostate biopsy negative for P.C.a who were later found to have P.C.a and underwent R.P., baseline P.A. is independently associated with lower risk of W.H.O./I.S.U.P. grade group ≥2 P.C.a on surgical pathology. P.A. may be used to identify subjects at lower risk for W.H.O./I.S.U.P. ≥ 2 P.C.a and select optimal candidates for active surveillance.
评估在最终被诊断为前列腺癌（P.C.a）并接受根治性前列腺切除术（R.P.）的男性中，前列腺活检阴性时前列腺萎缩（P.A.）的存在是否与手术病理时的前列腺癌（P.C.a）分级相关。
对来自度他雄胺降低前列腺癌事件（R.E.D.U.C.E.）试验安慰剂组的136名男性进行回顾性分析，这些男性基线前列腺活检结果为P.C.a阴性，随后在4年研究期间经活检确诊为P.C.a并接受了根治性前列腺切除术。在单变量和多变量分析中，采用逻辑回归评估基线时P.A.（存在/不存在）与手术病理时P.C.a分级（世界卫生组织/国际泌尿病理学会分级组1或≥2）之间的关联，并对基线患者特征进行控制。
在74例前列腺活检中观察到P.A.（54%）。P.A.与基线特征（年龄、体重指数、前列腺特异性抗原水平、前列腺体积、种族、P.C.a家族史和直肠指检）无关，但与慢性炎症有关（p = 0.001）。在单变量（比值比[O.R.] = 0.39，95%置信区间[C.I.] = 0.19 - 0.78，p = 0.008）和多变量（O.R. = 0.43，95% C.I. = 0.20 - 0.92，p = 0.029）分析中，基线前列腺活检中P.A.的存在与根治性前列腺切除标本中世界卫生组织/国际泌尿病理学会分级组≥2的P.C.a风险较低相关。
在基线前列腺活检为P.C.a阴性、随后被发现患有P.C.a并接受根治性前列腺切除术的男性中，基线P.A.与手术病理时世界卫生组织/国际泌尿病理学会分级组≥2的P.C.a风险较低独立相关。P.A.可用于识别世界卫生组织/国际泌尿病理学会≥2级P.C.a风险较低的受试者，并选择积极监测的最佳候选者。
