Crook J, Robertson S, Collin G, Zaleski V, Esche B
Department of Radiation Oncology, Ottawa Regional Cancer Centre, Canada.
Int J Radiat Oncol Biol Phys. 1993 Sep 1;27(1):31-7. doi: 10.1016/0360-3016(93)90418-u.
To correlate the results of routine transrectal ultrasound-guided prostate biopsies with the usual clinical parameters of digital rectal examination, prostate specific antigen and ultrasound in the follow-up of one hundred patients treated with radical radiotherapy for prostate cancer.
Stage distribution of the 100 patients was T1b; 19, T2a: 24, T2b: 36, T3: 20, T4: 1. Median follow-up is 26 months (range 15-48). One hundred forty-one ultrasound-guided biopsies have been performed with four to seven specimens at each examination. Initial biopsy was scheduled 12 months after radiotherapy and repeated every 6 months until negative or until there was clinical or biochemical evidence of recurrence.
Negative biopsies were obtained at 12 months (range 9-15) in only 52%. Of 31 patients with a positive first biopsy who have had a second or third examination, 21 converted to negative at 16-29 months (median: 19) (stage T1b: 3, T2a: 6, T2b: 8, T3: 4). All 21 patients had maintained a normal or decreasing prostate specific antigen (PSA). At last review, negative biopsies had been obtained in 74% patients: 79% (15/19) of T1b, 71% (17/24) of T2a, 72%, (26/36) of T2b, and 76% (16/21) of T3/4. No patient with a negative biopsy has had a local recurrence. Transrectal ultrasound alone (sens: 49%, spec: 57%) was no better than rectal exam (sens: 73%, spec: 66%) in predicting a positive post radiotherapy biopsy. Metastatic disease developed in seven patients, 12% (3/26) of those with a positive biopsy and 5% (4/74) of those with a negative biopsy (p < 0.01). All seven presented first with a rising PSA.
For patients with a positive biopsy 12 to 24 months after radiotherapy, PSA is the best indicator of biologically active tumor. This preliminary analysis indicates that there may be no need to treat patients with a positive biopsy and negative PSA in the absence of clinical recurrence.
将100例接受前列腺癌根治性放疗患者随访过程中常规经直肠超声引导下前列腺穿刺活检结果，与直肠指诊、前列腺特异性抗原及超声等常用临床参数进行相关性分析。
100例患者的分期分布为：T1b期19例，T2a期24例，T2b期36例，T3期20例，T4期1例。中位随访时间为26个月（范围15 - 48个月）。共进行了141次超声引导下穿刺活检，每次检查取4至7个标本。放疗后12个月安排首次活检，之后每6个月重复一次，直至活检结果为阴性或出现临床或生化复发证据。
仅52%的患者在12个月（范围9 - 15个月）时活检结果为阴性。31例首次活检阳性且接受了第二次或第三次检查的患者中，21例在16至29个月（中位时间：19个月）时转为阴性（T1b期：3例，T2a期：6例，T2b期：8例，T3期：4例）。所有21例患者的前列腺特异性抗原（PSA）均维持在正常或下降水平。在最后一次复查时，74%的患者活检结果为阴性：T1b期患者中79%（15/19），T2a期患者中71%（17/24），T2b期患者中72%（26/36），T3/4期患者中76%（16/21）。活检结果为阴性的患者均未出现局部复发。单独经直肠超声（敏感性：49%，特异性：57%）在预测放疗后活检阳性方面并不优于直肠指诊（敏感性：73%，特异性：66%）。7例患者发生转移，活检阳性患者中12%（3/26），活检阴性患者中5%（4/74）（p < 0.01）。所有7例患者均首先表现为PSA升高。
对于放疗后12至24个月活检阳性的患者，PSA是生物活性肿瘤的最佳指标。这项初步分析表明，在无临床复发的情况下，对于活检阳性但PSA阴性的患者可能无需进行治疗。
