Stenman Caroline, Abrahamsson Emelie, Redsäter Mikael, Gnanapragasam Vincent J, Bratt Ola
Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Urology, Halland Hospital, Varberg, Sweden.
Eur Urol Open Sci. 2022 Jun 11;41:123-125. doi: 10.1016/j.euros.2022.05.007. eCollection 2022 Jul.
European and American guidelines recommend abdominal computed tomography (CT) and bone scans for staging of high-risk prostate cancer (PC). To improve clinical risk stratification of nonmetastatic PC a new, five-tier risk classification system has been developed, the Cambridge Prognostic Groups (CPG), in which "high-risk" PC is divided into favourable CPG 4 and unfavourable CPG 5. We used the National Prostate Cancer Register of Sweden (NPCR) to define the rates of positive CT and bone scan findings among men with CPG 4 or 5 cancer. Among men with CPG 4 and prostate-specific antigen (PSA) <50 ng/ml, only 3.6% (95% confidence interval 2.9-4.5%) of the CT scans showed regional lymph-node metastasis (N1M0), while 6.2% (95% confidence interval 5.4-7.0%) of the bone scans were positive. Rates for both were higher in the subgroups with PSA 50-99 ng/ml (10% and 15%) and with CPG 5 disease. The low positivity rate questions routine use of CT for men with CPG 4 cancer and PSA <50 ng/ml, particularly considering the poor sensitivity and specificity for detection of lymph node metastasis. The positivity rate was higher for bone scans, and as current clinical practice relies on trials using bone scans for staging (eg, to define low- versus high-volume metastatic disease), continued routine use of bone scans seems justified.
Our analysis of data from the National Prostate Cancer Register of Sweden showed that for men with favourable high-risk prostate cancer (Cambridge Prognostic Group 4), the rate of positive computed tomography (CT) scans was low. This result suggests that CT scans may not be necessary for detecting cancer spread in men with Cambridge Prognostic Group 4 prostate cancer .
欧美指南推荐采用腹部计算机断层扫描（CT）和骨扫描对高危前列腺癌（PC）进行分期。为改善非转移性PC的临床风险分层，已开发出一种新的五级风险分类系统——剑桥预后分组（CPG），其中“高危”PC被分为预后良好的CPG 4和预后不良的CPG 5。我们利用瑞典国家前列腺癌登记处（NPCR）来确定CPG 4或5期癌症男性患者中CT和骨扫描阳性结果的发生率。在CPG 4且前列腺特异性抗原（PSA）<50 ng/ml的男性中，仅3.6%（95%置信区间2.9 - 4.5%）的CT扫描显示区域淋巴结转移（N1M0），而6.2%（95%置信区间5.4 - 7.0%）的骨扫描呈阳性。在PSA为50 - 99 ng/ml的亚组（分别为10%和15%）以及CPG 5期疾病患者中，两者的发生率更高。对于CPG 4期癌症且PSA<50 ng/ml的男性，低阳性率对CT的常规使用提出了质疑，尤其是考虑到其检测淋巴结转移的敏感性和特异性较差。骨扫描的阳性率更高，并且由于目前的临床实践依赖于使用骨扫描进行分期的试验（例如，用于定义低容量与高容量转移性疾病），因此继续常规使用骨扫描似乎是合理的。
我们对瑞典国家前列腺癌登记处数据的分析表明，对于预后良好的高危前列腺癌（剑桥预后分组4）男性患者，计算机断层扫描（CT）阳性率较低。这一结果表明，对于剑桥预后分组4期前列腺癌男性患者，检测癌症扩散可能无需进行CT扫描。
