Griebling T L, Williams R D
Department of Urology, University of Iowa, Iowa City 52242-1089, USA.
Semin Urol Oncol. 1996 Aug;14(3):156-64.
Numerous studies have confirmed the distinct biological behavior of two subsets of prostate cancer diagnosed incidentally after either transurethral resection (TURP) or open prostatectomy for presumed benign prostatic hyperplasia (BPH). Focal, low-grade lesions are associated with a low risk for clinical progression and are designated as stage T1a or A1. These cases have traditionally been managed conservatively with close clinical observation. In contrast, multifocal, high-volume, or high-grade tumors are associated with a more aggressive clinical course and are designated as stage T1b or A2. Early definitive intervention is usually advocated for these latter patients. Therefore, accurate pathological assignment to either stage T1a or T1b is crucial for selection of appropriate management options. A variety of methods for staging patients with incidentally detected prostate cancer have been proposed, including detailed histological analysis, repeat TURP or transurethral biopsy, serial prostate-specific antigen (PSA) analysis, and imaging with either transrectal ultrasound (TRUS) or magnetic resonance (MRI) techniques. This article critically examines the clinical utility of these staging modalities for patients with incidentally detected prostate cancer.
大量研究已证实，经尿道前列腺切除术（TURP）或开放性前列腺切除术治疗假定的良性前列腺增生（BPH）后偶然诊断出的前列腺癌两个亚组具有不同的生物学行为。局灶性、低级别病变临床进展风险低，被归为T1a期或A1期。传统上，这些病例采用密切临床观察的保守治疗方法。相比之下，多灶性、大体积或高级别肿瘤临床病程更具侵袭性，被归为T1b期或A2期。通常主张对后一组患者进行早期确定性干预。因此，准确病理分期为T1a期或T1b期对于选择合适的治疗方案至关重要。已经提出了多种对偶然发现的前列腺癌患者进行分期的方法，包括详细的组织学分析、重复TURP或经尿道活检、连续前列腺特异性抗原（PSA）分析以及经直肠超声（TRUS）或磁共振（MRI）技术成像。本文批判性地审视了这些分期方式对偶然发现的前列腺癌患者的临床实用性。
