Werner-Wasik M, Whittington R, Malkowicz S B, Corn B W, Arger P, Reisinger S, Langlotz C, Alexander A, D'Amico A V, Hyslop T, Gomella L, Brownstein K, Wein A J
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
Urology. 1997 Sep;50(3):385-9. doi: 10.1016/S0090-4295(97)00225-2.
Stage T1c carcinoma of the prostate is defined as a nonpalpable carcinoma (NPC-P) that is not visible by imaging and is identified by needle biopsy performed because of elevated prostate-specific antigen (PSA) concentrations. The purpose of this study was to define the incidence of normal findings on transrectal ultrasound (TRUS) and/or endorectal coil magnetic resonance imaging (EMRI) among patients with NPC-P, as well as to investigate the value of differentiating patients with Stage T1c disease from all other patients with NPC-P.
The records of 2211 patients diagnosed with prostate carcinoma between 1988 and 1995 were reviewed to identify 291 men with NPC-P. TRUS and EMRI reports were analyzed with regard to the presence and laterality of hypoechoic nodules or low-signal areas reported on T2-weighted images, respectively. Ninety percent of patients (n = 262) had at least six prostate biopsies, 185 patients (64%) underwent both TRUS and EMRI, 224 (77%) had TRUS, and 251 (86%) had an EMRI study.
Results were considered normal in 101 (47%) of 214 patients undergoing TRUS, in 58 (23%) of 249 undergoing EMRI, and in 22 (12%) of 185 undergoing both TRUS and EMRI. For the side of the prostate with positive biopsy results, correlation with imaging abnormalities was better for EMRI than for TRUS (39% versus 24%). There was no significant difference in mean PSA value, distribution of Gleason score, or unilateral versus bilateral positive biopsy results among patients with normal versus abnormal findings on both TRUS and EMRI.
(1) Only 12% of men with NPC-P have no TRUS or EMRI abnormalities, fulfilling the criteria for Stage T1c prostate carcinoma. (2) Those patients with Stage T1c disease do not differ from patients with NPC-P up-staged by TRUS or EMRI, with regard to pretreatment PSA levels, Gleason scores, and the probability of having bilateral rather than unilateral positive biopsy results. (3) The value of classifying patients with NPC-P into Stage T1c versus higher stages of prostate carcinoma on the basis of imaging should be questioned.
前列腺T1c期癌被定义为不可触及的癌（NPC - P），影像学检查不可见，因前列腺特异性抗原（PSA）浓度升高而行针吸活检确诊。本研究的目的是确定NPC - P患者经直肠超声（TRUS）和/或直肠内线圈磁共振成像（EMRI）检查结果正常的发生率，并探讨将T1c期疾病患者与所有其他NPC - P患者区分开来的价值。
回顾1988年至1995年间诊断为前列腺癌的2211例患者的记录，以确定291例NPC - P男性患者。分别分析TRUS和EMRI报告中T2加权图像上低回声结节或低信号区的存在情况及部位。90%的患者（n = 262）至少接受了6次前列腺活检，185例患者（64%）同时接受了TRUS和EMRI检查，224例（77%）接受了TRUS检查，251例（86%）接受了EMRI检查。
在接受TRUS检查的214例患者中，101例（47%）结果正常；在接受EMRI检查的249例患者中，58例（23%）结果正常；在同时接受TRUS和EMRI检查的185例患者中，22例（12%）结果正常。对于活检结果阳性的前列腺侧别，EMRI与影像学异常的相关性优于TRUS（39%对24%）。在TRUS和EMRI检查结果正常与异常的患者中，平均PSA值、Gleason评分分布或活检结果单侧阳性与双侧阳性的情况均无显著差异。
（1）只有12%的NPC - P男性患者TRUS和EMRI检查无异常，符合T1c期前列腺癌的标准。（2）T1c期疾病患者与因TRUS或EMRI检查而上调分期的NPC - P患者在治疗前PSA水平、Gleason评分以及活检结果为双侧阳性而非单侧阳性的概率方面并无差异。（3）基于影像学将NPC - P患者分为T1c期与前列腺癌更高分期的价值值得质疑。
