Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Computational and Experimental Biology Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal.
World J Urol. 2024 Nov 28;42(1):651. doi: 10.1007/s00345-024-05369-4.
Intraductal carcinoma (IDC) and cribriform pattern (Crib) of prostate cancer are recognised as independent prognosticators of poor outcome, both in prostate biopsies and radical prostatectomy (RP) specimens.
This study aimed to determine the predictive value of Free-to-total PSA ratio (FPSAR) in identifying missed IDC/Crib at the time of biopsy as compared to the final surgical specimen.
Patients who underwent RP between January 2015 and December 2022 were included in the study. Predictors of a false negative biopsy were examined using a multivariate logistic regression. Associations between true positive/true negative/false negative biopsies (for IDC/Crib) with FPSAR as primary outcome parameter were determined using Chi-squared test and Kruskal-Wallis test.
This study included 639 patients who underwent radical prostatectomy between 2015 and 2022 (Table 1) and had available FPSAR- at the time of biopsy. The median age was 63.0 years (IQR: 58.9-68.0). The median serum PSA before RP was 7.0 ng/ml (IQR: 5.3-9.5). Among the 639 patients, 177 (28%) had Crib, and 97 (15%) had IDC on prostate biopsy, with 54 (9%) patients having both IDC and Crib. Concerning Grade Group distribution at biopsy, there was: GG1 in 62 patients (10%), GG2 in 428 (67%), GG3 in 102 (16%), GG4 in 28 (4%), and GG5 in 19 (3%) patients. On multivariate regression analysis, the following were associated with lower odds of a false-negative IDC/Crib biopsy: Percentage of pattern 4 ≥ 10% at biopsy (odds ratio [OR] 0.17, 95% CI 0.10-0.29; p < 0.001); higher Gleason score (grade group 4/5) on biopsy (OR 0.38, 95% CI 0.16-0.91; p = 0.03) and higher percent of positive cores at biopsy ≥ 33% (OR 0.51, 95% CI 0.29-0.88; p = 0.02). FPSAR ≥ 0.10 was not an independent predictor of a false-negative IDC/Crib biopsy (p > 0.05).
In conclusion, our study's findings suggest that FPSAR is not a reliable biomarker for identifying IDC/Crib status at the time of biopsy. Further research is needed to identify biomarkers or combinations of biomarkers that can improve the diagnostic accuracy for these aggressive variants of PCa. Our study that involved 639 patients shows that FPSAR is not a good marker for detecting aggressive types of PCa, during a biopsy. More research is needed to find better markers or combinations of markers that can help diagnose these aggressive forms of prostate cancer more accurately.
在前列腺活检和根治性前列腺切除术（RP）标本中，导管内癌（IDC）和筛状模式（Crib）被认为是预后不良的独立预测因子。
本研究旨在确定游离前列腺特异性抗原与总前列腺特异性抗原比值（FPSAR）在识别活检时漏诊的 IDC/Crib 方面的预测价值，与最终手术标本相比。
纳入 2015 年 1 月至 2022 年 12 月期间接受 RP 的患者。使用多变量逻辑回归检查假阴性活检的预测因素。使用卡方检验和克鲁斯卡尔-沃利斯检验确定真阳性/真阴性/假阴性活检（用于 IDC/Crib）与 FPSAR 作为主要结局参数之间的关系。
本研究纳入了 2015 年至 2022 年期间接受根治性前列腺切除术的 639 例患者（表 1），并在活检时获得了 FPSAR-。中位年龄为 63.0 岁（IQR：58.9-68.0）。RP 前血清 PSA 中位数为 7.0ng/ml（IQR：5.3-9.5）。在 639 例患者中，177 例（28%）在前列腺活检时存在 Crib，97 例（15%）存在 IDC，54 例（9%）患者同时存在 IDC 和 Crib。关于活检时的分级分组分布，有：GG1 为 62 例（10%），GG2 为 428 例（67%），GG3 为 102 例（16%），GG4 为 28 例（4%），GG5 为 19 例（3%）。多变量回归分析显示，以下因素与较低的 IDC/Crib 活检假阴性几率相关：活检中模式 4≥10%的百分比（比值比 [OR] 0.17，95%CI 0.10-0.29；p<0.001）；较高的 Gleason 评分（分级组 4/5）（OR 0.38，95%CI 0.16-0.91；p=0.03）和较高的阳性核心百分比≥33%（OR 0.51，95%CI 0.29-0.88；p=0.02）。FPSAR≥0.10 不是 IDC/Crib 假阴性活检的独立预测因素（p>0.05）。
总之，我们的研究结果表明，FPSAR 不是在活检时识别 IDC/Crib 状态的可靠生物标志物。需要进一步研究以确定可以提高这些侵袭性前列腺癌变异体诊断准确性的生物标志物或生物标志物组合。我们的研究涉及 639 名患者，表明 FPSAR 不是一种很好的标志物，无法在活检时检测到侵袭性类型的前列腺癌。需要进一步研究以找到更好的标志物或标志物组合，以更准确地诊断这些侵袭性形式的前列腺癌。
