Ductal adenocarcinoma of the prostate diagnosed on needle biopsy - Correlation with clinical and radical prostatectomy findings and progression
Ductal adenocarcinoma of the prostate diagnosed on needle biopsy - Correlation with clinical and radical prostatectomy findings and progression
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DOI：
10.1097/00000478-199912000-00004
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发表时间：
1999-12-01
影响因子：
5.6
通讯作者：
Epstein, JI
中科院分区：
文献类型：
--
作者：
Brinker, DA;Potter, SR;Epstein, JI
前列腺导管腺癌，以前称为子宫内膜样癌，通常通过经尿道切除术诊断。当采用根治性前列腺切除术 (RP) 治疗时，其临床过程比普通腺泡前列腺癌更具侵袭性。前列腺癌在周围区域的针活检中发现具有导管特征的意义尚不清楚。我们回顾了 58 例患有导管腺癌的前列腺穿刺活检病例，我们能够获得这些病例的临床信息。患者的平均年龄为 69 岁（范围为 50-89 岁），血清前列腺特异性抗原水平（中位数为 7.9 ng/mL）和临床分期各不相同。六人 (10%) 在诊断时已发生转移。 86% 的病例可见筛状或乳头状结构或两种模式的混合，而在其余病例中，存在由高柱状细胞组成的离散腺体。 67%的病例中间质纤维化伴有导管癌。在 48% 的活检标本中发现了共存的腺泡癌成分。活检显示，导管成分平均占肿瘤的 82%。在接受 RP 治疗的 20 个肿瘤中，63% 的肿瘤出现前列腺外扩散，20% 的肿瘤切缘阳性。 2例（10%）出现精囊侵犯，但无淋巴结转移。阳性针芯数量与 RP 边缘状态 (p < 0.004) 和临床进展的可能性 (p < 0.02) 相关，但与器官受限状态无关。根据 11 个广泛采样的 RP 计算得出的肿瘤体积范围为 0.15 cm(3) 至 20.3 mt（平均值为 2.8 cm(3)）。治疗两年后，精算疾病进展风险在 34%（RP 患者）至 42%（所有患者）之间。与之前的腺泡癌男性研究组相比，观察到平均进展时间缩短。血清前列腺特异性抗原水平与 RP 器官局限性状态和肿瘤体积均不相关。我们的结论是，针吸活检中发现的前列腺导管腺癌意味着更晚期的癌症，且进展时间更短。
Ductal adenocarcinoma of the prostate, previously referred to as endometrioid cancer, is typically diagnosed on transurethral resection. When treated by radical prostatectomy (RP), it pursues a more aggressive clinical course than usual acinar prostate cancer does. The significance of prostate cancer with ductal features found on needle biopsies from the peripheral zone is unknown. We reviewed 58 prostate needle biopsy cases with ductal adenocarcinoma for which we were able to obtain clinical information. Patients had a mean age of 69 years (range, 50-89 years) and had a wide range of levels of serum prostate-specific antigen (median, 7.9 ng/mL) and clinical stages. Six (10%) had metastases at the time of diagnosis. Cribriform or papillary structures or a mixture of the two patterns were seen in 86% of cases, whereas in the remaining cases, discrete glands composed of tall columnar cells were present. Stromal fibrosis accompanied the ductal carcinoma in 67% of the cases. A coexisting acinar carcinoma component was identified in 48%, of the biopsy specimens. On biopsy, the ductal component composed a mean of 82% of the tumor. Of the 20 tumors treated by RP, 63% had extraprostatic spread of tumor and 20% had positive margins. Two (10%) cases showed seminal vesicle invasion, but none had lymph node metastases. The number of positive needle cores correlated with RP margin status (p < 0.004) and with likelihood of clinical progression (p < 0.02), but not with organ-confined status. Tumor volume calculated on the 11 extensively sampled RPs ranged from 0.15 cm(3) to 20.3 mt (mean, 2.8 cm(3)). Two years after therapy, the actuarial risk of progression was between 34% (RP patients) and 42% (all patients). A shortened average time to progression was observed relative to a previous study group of men with acinar carcinoma. Serum prostate-specific antigen levels correlated with neither RP organ-confined status nor tumor volume. We conclude that prostatic ductal adenocarcinoma seen on needle biopsy implies more advanced cancer with a shortened time to progression.