不可触及的T1c期前列腺癌：利用游离/总前列腺特异性抗原水平和穿刺活检结果预测微小疾病

Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings.

作者信息

Epstein J I, Chan D W, Sokoll L J, Walsh P C, Cox J L, Rittenhouse H, Wolfert R, Carter H B

机构信息

Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.

出版信息

J Urol. 1998 Dec;160(6 Pt 2):2407-11.

PMID:9817393

Abstract

PURPOSE

Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance.

MATERIALS AND METHODS

We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant.

RESULTS

Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced.

CONCLUSIONS

In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.

摘要

目的

对于T1c期疾病实施的根治性前列腺切除术，约25%显示为潜在意义不大的前列腺癌。我们之前报道了利用血清前列腺特异性抗原（PSA）密度和穿刺活检结果来预测潜在意义不大的癌症。我们现在评估联合使用游离/总血清PSA水平与穿刺活检结果能否更好地预测肿瘤的意义。

材料与方法

我们研究了163例T1c期前列腺癌根治性前列腺切除术标本，测定了游离/总血清PSA水平。采用串联MP PSA检测法测量游离/总血清PSA水平。意义不大的前列腺癌局限于器官内，肿瘤体积小于0.5立方厘米，Gleason评分小于7分。进展期肿瘤为Gleason评分7分或更高、已确定有前列腺外侵犯且切缘阳性、或精囊或淋巴结阳性。其他病例视为中度肿瘤。中度和进展期肿瘤被视为有意义。

结果

在这些肿瘤中，30.7%意义不大，49.7%为中度，19.6%为进展期。预测术前意义不大肿瘤的最佳模型是游离/总PSA为0.15或更高且穿刺活检结果良好（累及芯针少于3个，无芯针肿瘤累及超过50%且Gleason评分小于7分）。使用该模型，预测为意义不大的18例肿瘤中有17例意义不大，阳性预测值为94.4%。在预测为有意义的145例病例中，112例预测正确，阴性预测值为77.2%。仅1例预测为意义不大的肿瘤被归类为中度。无预测为意义不大的肿瘤为进展期。