Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Prostate. 2019 Sep;79(13):1523-1529. doi: 10.1002/pros.23873. Epub 2019 Jul 3.
Active surveillance (AS) is one of the treatment alternatives in low-risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study.
Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty-six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate-specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading).
Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76-10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08-27.4; P = .04) were independently associated with GU.
Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low-risk patients with PCa.
主动监测（AS）是低危前列腺癌（PCa）的治疗选择之一。本研究调查了接受 RP 时符合 AS 条件的患者术后病理升级情况。
2006 年 8 月至 2017 年 7 月，我院共 627 例患者接受 RP。本研究纳入了 67 例在 RP 时符合 AS 标准的患者，其中 Gleason 评分 3+3=6 分（在最大的两个活检组织中），前列腺特异抗原（PSA）<10ng/ml，临床 T 分期≤2a。回顾性比较两组患者的人口统计学、临床和组织病理学结果，根据最终病理结果分为 2 组：第 1 组（n=67，升级）和第 2 组（n=69，未升级）。
67 例（49.3%）患者发生 Gleason 升级（GU），17 例（12.5%）患者升级为 pT3a。38.7%的患者升级为 Gleason 3+4，7.4%和 3.7%的患者升级为 Gleason 4+3 和 Gleason 4+4。10.3%的患者存在前列腺外侵犯，第 1 组的发生率（19.4%比 1.4%，P=0.002）显著更高。RP 标本中 PSA 密度（P=0.001）、肿瘤大小（P<0.001）、肿瘤百分比（P<0.001）、尖部累及（P=0.013）和神经周围侵犯（P<0.001）在第 1 组中更高。多因素分析显示，神经周围侵犯（OR=4.26；95%CI：1.76-10.33；P=0.001）和病理 T 分期（OR=5.45；95%CI：1.08-27.4；P=0.04）与 GU 独立相关。
由于 12.5%的患者升级为 pT3a 疾病，并且存在 Gleason 4 模式的潜在风险，因此在向低危 PCa 患者提供 AS 之前，应仔细考虑肿瘤的升级。
