Expectant management of nonpalpable prostate cancer with curative intent: Preliminary results
Expectant management of nonpalpable prostate cancer with curative intent: Preliminary results
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DOI：
10.1016/s0022-5347(05)65271-8
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发表时间：
2002-03-01
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;Walsh, PC;Epstein, JI
目的：探讨T1c期前列腺癌患者的保守治疗策略。材料与方法：81例T1c期前列腺癌患者，年龄52~72岁，中位年龄65岁，经针吸活检和前列腺特异性抗原(PSA)密度检查确诊为小体积前列腺癌，随访1年以上，每半年进行一次PSA和直肠指检，每年一次前列腺活检(中位随访23个月，12~58个月)。如果不良的后续针吸活检结果表明疾病进展，则建议治疗(Gleason分型4或5，多于2个癌症活检核心，任何核心癌症累及超过50%)。根治性前列腺癌的病理检查定义为：1)Gleason评分<7分的器官受限癌，2)Gleason评分<7(3+4)且切缘、精囊和淋巴结阴性的前列腺癌，或(3)Gleason评分<6分的癌，无论切缘状况如何，精囊和淋巴转移阴性。结果：81例男性中，25例(31%)有疾病进展。与无疾病进展的男性相比，男性PSA密度显著升高(p=0.01)，游离PSA百分比显著降低(p=0.04)。39名男性中有22名(56%)发生了疾病进展，每次随访活检均显示为癌症，而42名男性中有3名(2%)有1次或1次以上的随访阴性活检(p
Purpose: We evaluate a strategy of expectant management for men with stage T1c prostate cancer.Materials and Methods: A total of 81 men (median age 65 years, range 52 to 72) with stage T1c prostate cancer who were thought to have small volume prostate cancer based on needle biopsy findings and prostate specific antigen (PSA) density were followed for more than 1 year with semiannual PSA and digital rectal examination, and annual prostate biopsies (median followup 23 months, range 12 to 58). A recommendation for treatment was made if disease progression was indicated by unfavorable followup needle biopsy findings (Gleason pattern 4 or 5, greater than 2 biopsy cores with cancer, greater than 50% involvement of any core with cancer). Curable disease was defined on pathological examination of radical prostatectomy specimens as 1) organ confined cancer of Gleason score 7 or less, 2) cancer with extraprostatic extension of Gleason score 7 (3 + 4) or less with negative margins, seminal vesicles and lymph nodes, or 3) cancer of Gleason score 6 or less regardless of margin status or extraprostatic extension if negative seminal vesicles and lymph nodes.Results: Of the 81 men 25 (31%) had progression of disease at followup. PSA density was statistically significantly higher (p = 0.01) and the percentage of free PSA was statistically significantly lower (p = 0.04) in men with compared to those without disease progression. Disease progression occurred in 22 of 39 men (56%) with every followup biopsy showing cancer compared to 3 of 42 (2%) men with 1 or more negative followup biopsies (p