Humphrey P A, Keetch D W, Smith D S, Shepherd D L, Catalona W J
Department of Pathology (Lauren V. Ackerman Surgical Pathology Laboratory), Washington University Medical Center, St. Louis, Missouri,USA.
J Urol. 1996 Mar;155(3):816-20.
Many small (less than 0.5 cc), well differentiated, organ-confined prostate carcinomas remain clinically undetected during the life of the patient and are identified only at postmortem examination. Thus, these cancers are often called latent or autopsy cancers. There is concern that serum prostate specific antigen (PSA) based screening may preferentially detect these cancers. There are limited prospective data concerning the pathological features of carcinomas of the prostate detected in a screening program. We determined if prostatic carcinomas detected via PSA based screening resembled autopsy cancers.
We assessed the pathological features of carcinomas in 100 consecutive, completely embedded radical prostatectomy specimens from men whose cancer was detected in a PSA based screening program. The tumors were evaluated for pathological stage, surgical margin status, Gleason histological grade and intraglandular tumor extent (morphometrically quantified as percentage carcinoma and tumor volume).
Of 100 carcinomas 68 (68%) were larger than 0.5 cc in volume (mean 1.7, range 0.1 to 10.7). Mean amount of carcinoma in the surgical specimen was 10.3% (range 0.1 to 41.6). Of the 100 carcinomas 94 had a Gleason score of 5 to 8 (mean 5.7) and only 6 (6%) were well differentiated (Gleason score of 4 or less). Locally advanced disease was noted in 41 cases (41%) as judged by the presence of extracapsular carcinoma and/or cancerous surgical margins.
We concluded that the pathological features of most prostatic carcinomas detected via PSA based screening do not resemble those of autopsy cancers, and that most prostatic cancers detected in screening programs are likely to be clinically important.
许多体积较小（小于0.5立方厘米）、高分化、局限于器官内的前列腺癌在患者生前临床上未被检测到，仅在尸检时才被发现。因此，这些癌症常被称为潜伏性或尸检癌症。有人担心基于血清前列腺特异性抗原（PSA）的筛查可能会优先检测出这些癌症。关于在筛查项目中检测到的前列腺癌的病理特征的前瞻性数据有限。我们确定通过基于PSA的筛查检测出的前列腺癌是否与尸检癌症相似。
我们评估了100例连续的、完全包埋的根治性前列腺切除术标本中癌症的病理特征，这些患者的癌症是在基于PSA的筛查项目中检测到的。对肿瘤进行病理分期、手术切缘状态、Gleason组织学分级和腺内肿瘤范围（形态计量学量化为癌百分比和肿瘤体积）评估。
100例癌症中，68例（68%）体积大于0.5立方厘米（平均1.7，范围0.1至10.7）。手术标本中癌的平均含量为10.3%（范围0.1至41.6）。100例癌症中，94例Gleason评分为5至8（平均5.7），只有6例（6%）为高分化（Gleason评分为4或更低）。根据包膜外癌和/或癌性手术切缘的存在判断，41例（41%）有局部晚期疾病。
我们得出结论，通过基于PSA的筛查检测到的大多数前列腺癌的病理特征与尸检癌症不同，并且在筛查项目中检测到的大多数前列腺癌可能具有临床重要性。
