Pathological features after radical prostatectomy in potential candidates for active monitoring
Pathological features after radical prostatectomy in potential candidates for active monitoring
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DOI：
10.1016/j.juro.2007.05.016
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发表时间：
2007-09-01
影响因子：
6.6
通讯作者：
Catalona, William J.
中科院分区：
文献类型：
--
作者：
Griffin, Christopher R.;Yu, Xiaoying;Catalona, William J.
目的：对于小体积、活检Gleason 6级或以下前列腺癌患者，观察等待或积极监测方案的结果有许多报道。当向低级别前列腺癌患者咨询治疗方案时，了解手术治疗在这一人群中的效果是有用的。材料和方法：在当代根治性前列腺切除术系列中，有455例活检Gleason 3 + 3级前列腺癌患者和活检阳性核数的信息。其中292人在2个或更少阳性核的基础上患有小容量疾病。结果：292例低体积Gleason 3 + 3前列腺癌患者中有245例（84%）有器官局限性疾病。78名男性（27%）前列腺切除术标本的Gleason评分为7分或更高，25名（8%）有囊外肿瘤扩展，29名（10%）有手术边缘阳性。在这些患者中，术前变量不是不良病理特征的可靠预测因子。结论：超过三分之一的Gleason 3 + 3肿瘤在根治性前列腺切除术标本中升级或有其他不良病理特征。我们的研究结果表明，小体积Gleason 3 + 3前列腺癌经常分期不清，立即根治性前列腺切除术治疗与良好的预后相关。
Purpose: There are numerous reports on the results of watchful waiting or active monitoring protocols for men with low volume, biopsy Gleason grade 6 or less prostate cancer. When counseling patients with low grade prostate cancer about treatment options, it is useful to know the results of surgical treatment in this population.Materials and Methods: In a contemporary radical prostatectomy series there were 455 patients with biopsy Gleason grade 3 + 3 prostate cancer and information on the number of positive biopsy cores. Of these men 292 had low volume disease on the basis of 2 or fewer positive cores.Results: Overall 245 of 292 men (84%) with low volume Gleason 3 + 3 prostate cancer on biopsy had organ confined disease. The Gleason score in the prostatectomy specimen was 7 or greater in 78 men (27%), 25 (8%) had extracapsular tumor extension and 29 (10%) had positive surgical margins. In these patients preoperative variables were not reliable predictors of adverse pathological features.Conclusions: More than a third of Gleason 3 + 3 tumors on biopsy were upgraded in the radical prostatectomy specimen or had other adverse pathological features. Our results suggest that low volume Gleason 3 + 3 prostate cancer is frequently under staged, and that immediate therapy with radical prostatectomy is associated with favorable outcomes.