Uzzo R G, Wei J T, Waldbaum R S, Perlmutter A P, Byrne J C, Vaughan E D
Department of Urology, James Buchanan Brady Foundation, New York Hospital-Cornell University Medical Center, NY 10021, USA.
Urology. 1995 Dec;46(6):831-6. doi: 10.1016/s0090-4295(99)80353-7.
To determine if cancer detection rates vary with prostate size using a sextant core biopsy pattern.
We reviewed 1021 transrectal ultrasound (TRUS)-guided sextant pattern prostate biopsies to determine if cancer detection varied based on prostate size. Prostate size was determined using a computer generated elliptical estimation method. Sextant core biopsies were taken, and the patients divided into groups based on estimated size of the prostate and biopsy outcome. Large prostates were those that were estimated by TRUS as 50 cc or more. Prostates were considered small if they were less than 50 cc. Groups were compared based on size and biopsy outcome.
Adenocarcinoma was detected in 33% (334 of 1021) of the patients. Large prostates were noted in 34% (346 of 1021), of which 23% (80 of 346) had cancer detected by sextant biopsy. Small prostates were noted in 66% (675 of 1021), of which 38% (254 of 675) had cancer detected. The difference in cancer detection in large and small glands using a sextant pattern was statistically significant (P < 0.01). Patients with positive biopsies had significantly smaller prostate sizes (40 cc +/- 26) when compared with those with negative biopsies (51 cc +/- 33) (P < 0.01). Only 14% (8 of 58) of patients with gland sizes 100 cc or greater had positive sextant biopsies while 49% (118 of 239) with prostates 25 cc or less had cancer detected. Multivariate statistical analysis was used to control for differences in age, prostate-specific antigen (PSA), PSA density, TRUS findings, and digital rectal examination between the large and small prostate groups. The difference in cancer detection persisted (P < 0.05)
Currently no evidence exists to support differing cancer rates based on gland size alone. Our cancer detection rate using a sextant pattern was higher in men with prostates less than 50 cc, and patients diagnosed with cancer had significantly smaller prostates than those with a negative sextant biopsy. Our data suggest that significant sampling error may occur in men with large glands, and more biopsies may be needed under these circumstances. The effects of tumor volume, focality, and specimen size in relation to overall gland size may contribute to these findings.
采用六分区穿刺活检模式确定癌症检出率是否随前列腺大小而变化。
我们回顾了1021例经直肠超声（TRUS）引导下的六分区前列腺穿刺活检病例，以确定癌症检出率是否因前列腺大小而异。前列腺大小采用计算机生成的椭圆估计法确定。进行六分区穿刺活检，并根据前列腺估计大小和活检结果将患者分组。大前列腺是指经TRUS估计为50立方厘米或更大的前列腺。前列腺小于50立方厘米则视为小前列腺。根据大小和活检结果对各组进行比较。
33%（1021例中的334例）患者检测到腺癌。大前列腺占34%（1021例中的346例），其中23%（346例中的80例）经六分区活检检测到癌症。小前列腺占66%（1021例中的675例），其中38%（675例中的254例）检测到癌症。采用六分区模式时，大、小腺体癌症检出率的差异具有统计学意义（P<0.01）。活检阳性的患者前列腺大小（40立方厘米±26）显著小于活检阴性的患者（51立方厘米±33）（P<0.01）。腺体大小为100立方厘米或更大的患者中，只有14%（58例中的8例）六分区活检呈阳性，而前列腺为25立方厘米或更小的患者中，49%（239例中的118例）检测到癌症。采用多变量统计分析来控制大、小前列腺组在年龄、前列腺特异性抗原（PSA）、PSA密度、TRUS检查结果和直肠指检方面的差异。癌症检出率的差异仍然存在（P<0.05）。
目前尚无证据支持仅基于腺体大小存在不同的癌症发生率。我们采用六分区模式时，前列腺小于50立方厘米的男性癌症检出率更高，且被诊断为癌症的患者前列腺明显小于六分区活检阴性的患者。我们的数据表明，大腺体男性可能存在显著的取样误差，在这种情况下可能需要更多的活检。肿瘤体积、局灶性以及标本大小与整个腺体大小的关系可能导致了这些结果。
