术前 PSA 水平预测内镜下前列腺大腺瘤剜除术时偶然发现的临床显著移行区前列腺癌的准确性。

Accuracy of the preoperative PSA level for predicting clinically significant incidental transitional zone-prostate cancer before endoscopic enucleation of very large adenoma.

机构信息

Department of Urology, Clinique Pasteur, 31300, Toulouse, France.

Department of Pathology, S.O. Path, Toulouse, France.

出版信息

World J Urol. 2020 Apr;38(4):993-1000. doi: 10.1007/s00345-019-02823-6. Epub 2019 May 28.

DOI:10.1007/s00345-019-02823-6

PMID:31139906

Abstract

OBJECTIVE

To analyse the accuracy of high preoperative PSA levels for predicting transitional zone incidental PCa (TZ-PCa) in men with very large prostates.

MATERIALS AND METHODS

Perioperative data from 375 consecutive patients who underwent endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction between July 2013 and December 2018 were retrospectively reviewed. Patients were stratified into three groups according to the preoperative PSA level: low-PSA (< 4 ng/mL), intermediate-PSA (4 ≤ PSA < 10 ng/mL) and high-PSA (≥ 10 ng/mL). Men in each group were propensity score matched by age, 5α-reductase inhibitor (5-ARI) use, prostate volume and mpMRI. The TZ-PCa incidence rate was retrospectively compared by preoperative PSA level in a propensity score model including all predetermined variables.

RESULTS

Age, prostate volume, 5-ARI use were similar between patient groups. The median PSA levels in the low-, intermediate- and high-PSA groups were 3 [2.3; 3.4], 6.6 [5.3; 8.1] and 12.7 [11; 16.7] ng/mL, respectively. The median prostate volume was > 100 grams in all groups (108, 105 and 120 cc, respectively). The T1a-Gleason 6 incidental TZ-PCa rate was statistically comparable between the three groups (3.4, 5.1 and 8.6% in the low-, intermediate- and high-PSA groups, respectively). The detection rate of clinically significant TZ-PCa was low for preoperative PSA levels > 4 ng/mL (1.7%); with no difference between the intermediate- and high-PSA groups.

CONCLUSION

In men with large glands, the clinically significant incidental TZ-PCa detection rate was similar regardless of the preoperative PSA level stratum. Such details may help with patient counselling during BPH surgical management.

摘要

目的

分析术前高 PSA 水平预测前列腺体积较大患者的移行区偶发前列腺癌（TZ-PCa）的准确性。

材料与方法

回顾性分析 2013 年 7 月至 2018 年 12 月期间 375 例因良性前列腺增生行内镜前列腺切除术（EEP）的连续患者的围手术期数据。根据术前 PSA 水平将患者分为三组：低 PSA（<4ng/ml）、中 PSA（4ng/ml≤PSA<10ng/ml）和高 PSA（PSA≥10ng/ml）。每组患者根据年龄、5α-还原酶抑制剂（5-ARI）使用、前列腺体积和 mpMRI 进行倾向评分匹配。在包括所有预定变量的倾向评分模型中，比较各组患者的术前 PSA 水平与 TZ-PCa 发生率。

结果

年龄、前列腺体积、5-ARI 使用在各组间无差异。低、中、高 PSA 组的中位 PSA 水平分别为 3[2.3;3.4]、6.6[5.3;8.1]和 12.7[11;16.7]ng/ml，中位前列腺体积分别为 108、105 和 120cc。三组的前列腺体积均>100g。低、中、高 PSA 组 T1a-Gleason 6 偶然 TZ-PCa 发生率无统计学差异（分别为 3.4%、5.1%和 8.6%）。术前 PSA 水平>4ng/ml 时临床显著 TZ-PCa 的检出率较低（1.7%），且中、高 PSA 组间无差异。