Prospective evaluation of men with stage T1c adenocarcinoma of the prostate
Prospective evaluation of men with stage T1c adenocarcinoma of the prostate
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DOI：
10.1016/s0022-5347(01)64719-0
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发表时间：
1997-06-01
影响因子：
6.6
通讯作者：
Epstein, JI
中科院分区：
文献类型：
--
作者：
Carter, HB;Sauvageot, J;Epstein, JI
目的：在广泛的前列腺特异性抗原（PSA）检测时代，确定Tie期癌症的病理学特征，并评估预处理参数预测Tie期疾病男性肿瘤显著性的能力。材料和方法：在1994年至1996年间，336名患有Tie期前列腺癌的男性中，根治性手术71.4%，放疗20例（6%），保守治疗76例（22.6%）。治疗建议是基于先前确定的预测显著阶段Tie癌症（超过0.2 cm）的标准。(3))：1）PSA密度0.15 ng./毫升。/ GM.或更高，2）Gleason评分7或更高，3）3个或更多个核心涉及癌症，或4）50%或更多的任何核心涉及癌症。经病理学评价，切除标本的肿瘤分类为无意义（局限性肿瘤小于0.2 cm）。Gleason评分小于7）、最小（局限性肿瘤0.2至小于0.5cm。(3)Gleason评分小于7）、中度（0.5cm. (3)或更大的疾病，或Gleason评分小于7的包膜穿透）和晚期（Gleason评分为7或更高的包膜穿透，或阳性边缘、精囊或淋巴结）。结果：240例行根治性切除术的Tie期乳腺癌患者中，无肿瘤40例（17%），微小肿瘤29例（12%），中度肿瘤124例（52%），晚期肿瘤47例（19%）。在比较Tie分期系列（1988年至1992年与1994年至1996年）时，注意到器官局限性癌症的增加（51%至72%）和阳性边缘的减少（17%至8%），但不显著肿瘤的百分比在系列之间保持稳定（16%与17%）。超声和六分仪活检可用于审查72例（当前系列）。如果用于推荐治疗的治疗前标准提示有显著肿瘤（64例），则仅10例（16%）存在无显著肿瘤。如果治疗前标准提示肿瘤不明显（8例），则6例（75%）存在不明显或极轻微肿瘤，2例（25%）存在中度器官局限性疾病。没有病变的超声和测量的总长度内的活检samples. Conclusions的癌症并不预示着一个微不足道的tumor.Conclusions：在一个nonscreened人口阶段Tie癌症被发现较早与广泛的PSA检测。即使检测到早期癌症，我们也证明了使用预处理标准来咨询男性关于适当的管理选择，可以最大限度地减少将接受根治性直肠癌切除术的小肿瘤患者的数量。
Purpose: The pathological characteristics of stage Tie cancers in the era of widespread prostate specific antigen (PSA) testing were determined, and the ability of pretreatment parameters to predict tumor significance in men with stage Tie disease was evaluated.Materials and Methods: Of 336 men with stage Tie prostate cancer seen between 1994 and 1996, 240 (71.4%) were treated with radical prostatectomy, 20 (6%) with radiation therapy and 76 (22.6%) expectantly. Recommendations for treatment were based on previously determined criteria predictive of a significant stage Tie cancer (more than 0.2 cm.(3)): 1) PSA density 0.15 ng./ml./gm. or more, 2) Gleason score 7 or greater, 3) 3 or more cores involved with cancer, or 4) 50% or more involvement of any core with cancer. Pathological evaluation of prostatectomy specimens allowed classification of tumors as insignificant (confined tumor smaller than 0.2 cm. with a Gleason score of less than 7), minimal (confined tumor 0.2 to less than 0.5 cm.(3) with a Gleason score of less than 7), moderate (0.5 cm.(3) or larger disease, or capsular penetration with a Gleason score of less than 7) and advanced (capsular penetration with a Gleason score of 7 or more, or positive margins, seminal vesicles or lymph nodes). Pathological characteristics of tumors in this series were compared to a previous series of 157 men with stage Tie cancers who underwent radical prostatectomy between 1988 and 1992.Results: Of 240 men who underwent radical prostatectomy tumors were insignificant in 40 (17%), minimal in 29 (12%), moderate in 124 (52%) and advanced in 47 (19%). An increase in organ confined cancers (51 to 72%) and a decrease in positive margins (17 to 8%) were noted when comparing stage Tie series (1988 to 1992 versus 1994 to 1996) but the percentage of insignificant tumors remained stable (16 versus 17%) between series. Ultrasound and sextant biopsies were available for review in 72 cases (current series). If the pretreatment criteria used to recommend therapy suggested significant tumor (64 cases) then insignificant tumor was present in only 10 (16%). If pretreatment criteria suggested insignificant tumor (8 cases), insignificant or minimal tumor was present in 6 (75%) and moderate organ confined disease was present in 2 (25%). The absence of a lesion on ultrasound and measurement of total length of cancer within the biopsy specimen were not predictive of an insignificant tumor.Conclusions: In a nonscreened population stage Tie cancers are being discovered earlier with widespread PSA testing. Even with the detection of earlier cancers we demonstrated that it is possible to minimize the number of patients with small tumors who will undergo radical prostatectomy using pretreatment criteria to counsel men regarding appropriate management options.