Elgamal A A, Van Poppel H P, Van de Voorde W M, Van Dorpe J A, Oyen R H, Baert L V
Department of Urology, University Hospitals of Katholieke Universiteit Leuven, Belgium.
J Urol. 1997 Jan;157(1):244-50. doi: 10.1016/s0022-5347(01)65337-0.
We analyzed 100 consecutive radical prostatectomy specimens to evaluate the extent and clinical relevance of the stage T1c cancers discovered.
All cases were diagnosed by systematic prostatic puncture biopsies because of abnormal prostate specific antigen (PSA) or PSA density. Surgical specimens were examined with the whole organ multiple step-section technique (4 mm.) to identify primary tumor location (peripheral or transition zone cancer), tumor volume, tumor volume divided by prostate volume (percent tumor volume), Gleason score, pathological T stage and positive surgical margins. Tumors smaller than 0.5 cm.3 and without unfavorable pathology (Gleason score 7 or more, or positive surgical margins) were considered insignificant.
Median patient age, PSA, tumor volume and Gleason score were 64 years, 8.8 micrograms./l., 1.6 cm.3 and 6, respectively. Of the specimens 46 (46%) had transition zone cancer that was clinically undetectable due to anterior location, while peripheral zone cancers were small, diffuse, anterolateral or in large glands with low percent tumor volume. Transition zone cancer showed greater PSA, PSA density, tumor volume and percent tumor volume than peripheral zone cancer (p = 0.08, 0.03, 0.0002 and 0.0004, respectively), yet with similar Gleason score (p = 0.4). Of the tumors 34 (34%) were locally advanced (stage pT3 and/or positive surgical margins, mostly anterior in 16 transition zone cancers, and apical or posterolateral in 18 peripheral zone cancers), whereas 22 were insignificant (6 transition and 16 peripheral zone cancers). Prostatic puncture biopsies with a core cancer length of less than 3 mm. could have predicted 18 of 19 insignificant tumors but underestimated 13 (33%) and 6 (17%) significant transition and peripheral zone cancers.
The majority of our stage T1c tumors were significant with a distinguished high incidence of transition zone cancer. Therefore, they were large but occult. Transition zone cancer behaved differently than peripheral zone cancer, and warranted considerations during treatment of stage T1c prostate carcinoma.
我们分析了100例连续的根治性前列腺切除术标本，以评估所发现的T1c期癌症的范围及临床相关性。
所有病例均因前列腺特异性抗原（PSA）或PSA密度异常而通过系统性前列腺穿刺活检确诊。手术标本采用全器官多步骤切片技术（4毫米）进行检查，以确定原发肿瘤位置（外周区或移行区癌）、肿瘤体积、肿瘤体积除以前列腺体积（肿瘤体积百分比）、Gleason评分、病理T分期及手术切缘阳性情况。肿瘤体积小于0.5立方厘米且无不良病理特征（Gleason评分7分或更高，或手术切缘阳性）的肿瘤被视为无意义。
患者年龄中位数、PSA、肿瘤体积及Gleason评分分别为64岁、8.8微克/升、1.6立方厘米及6分。46例（46%）标本为移行区癌，因其位于前方临床上无法检测到，而外周区癌较小、呈弥漫性、位于前外侧或存在于肿瘤体积百分比低的大腺体中。移行区癌的PSA、PSA密度、肿瘤体积及肿瘤体积百分比均高于外周区癌（p分别为0.08、0.03、0.0002及0.0004），但Gleason评分相似（p = 0.4）。34例（34%）肿瘤为局部进展期（pT3期和/或手术切缘阳性，16例移行区癌大多位于前方，18例外周区癌位于尖部或后外侧），而22例无意义（6例移行区癌和16例外周区癌）。癌芯长度小于3毫米的前列腺穿刺活检可预测19例无意义肿瘤中的18例，但低估了13例（33%）有意义的移行区癌和6例（17%）有意义的外周区癌。
我们的大多数T1c期肿瘤有意义，移行区癌的发生率显著较高。因此，它们体积大但隐匿。移行区癌的表现与外周区癌不同，在T1c期前列腺癌的治疗过程中值得考虑。
