磁共振成像(MRI)对前列腺癌分期的临床意义(英文)

目的探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法对32例病理证实的局限性前列腺癌行根治性手术前经直肠指诊进行临床分期及 MRI 分期预测术后前列腺病理分期结果,评价其预测前列腺癌病理分期的诊断性结果。结果本组32例前列腺癌中,临床分期局限于前列腺内的肿瘤(B 期)30例,10例前列腺癌根治术后病理诊断有前列腺包膜及包膜外浸润,1例左髂血管旁淋巴结转移癌,36.7%(11/30)病例临床分期偏低,2例临床分期为 C 期病例术后1例为 B 期,临床分期偏高。而 MRI 诊断的30例前列腺癌中,分期局限于前列腺内的肿瘤(B 期)21例中,4例前列腺根治术后病理诊断为 C 期,19.1%(4/21)的病例 MRI 分期偏低;9例 MRI 分期为 C 期病例1例术后为 B 期,分期偏高,另1例术后为 D1期,分期偏低。直肠指诊临床分期和 MRI 分期预测前列腺癌的病理结果有显著相关性(P=0.002)。临床分期和 MRI 分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3%和80.9%;对浸润包膜及包膜外肿瘤的预测(NPV)分别为50.0%和88.9%、MRI 对前列腺癌病理分期的预测更具有特异性和较高的准确性,能更好的预测前列腺癌的病理结果(P=0.023)。结论 MRI 分期较直肠指诊临床分期能更好地预测局限于前列腺内的肿瘤,对前列腺包膜及包膜以外浸润的肿瘤能进行更准确的分期。     

磁共振成像(MRI)对前列腺癌分期的临床意义

目的 探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法 对32例病理证实的局限性前列腺癌行根治性手术前经直肠指诊进行临床分期及MRI分期预测术后前列腺病理分期结果,评价其预测前列腺癌病理分期的诊断性结果。结果 本组32例前列腺癌中,临床分期局限于前列腺内的肿瘤(B期)30例,10例前列腺癌根治术后病理诊断有前列腺包膜及包膜外浸润,1例左髂血管旁淋巴结转移癌,36.7％(11/30)病例临床分期偏低,2例临床分期为C期病例术后1例为B期,临床分期偏高。而MRI诊断的30例前列腺癌中,分期局限于前列腺内的肿瘤(B期)21例中,4例前列腺根治术后病理诊断为C期,19.1％(4/21)的病例MRI分期偏低;9例MRI分期为C期病例1例术后为B期,分期偏高,另1例术后为D1期,分期偏低。直肠指诊临床分期和MRI分期预测前列腺癌的病理结果有显著相关性(P=0.002)。临床分期和MRI分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3％和80.9％;对浸润包膜及包膜外肿瘤的预测(NPV)分别为50.0％和88.9％。MRI对前列腺癌病理分期的预测更具有特异性和较高的准确性,能更好的预测前列腺癌的病理结果(P=0.023)。结论 MRI分期较直肠指诊临床分期能更好地预测局限于前列腺内的肿瘤,对前列腺包膜及包膜以外浸润的肿瘤能进行更准确分     

临床分期和磁共振成像(MRI)对前列腺癌分期的临床意义

目的：探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法：对32例局限性前列腺癌术前经直肠指诊进行临床分期及MRI分期预测前列腺癌根治术后的病理分期结果，评价诊断性实验结果。结果：直肠指诊临床分期和MRI分期预测前列腺癌的病理结果有显著相关性(P=0．002)。临床分期和MRI分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3％和80．9％；对浸润包膜及包膜外肿瘤的预测(NPV)分别为50．0％和88．9％。MRI对前列腺癌病理分期的预测更具有特异性和较高的准确性，能更好的预测前列腺癌的病理结果(P=0．023)。结论：MRI较直肠指诊能更好地预测局限于前列腺内的肿瘤，对前列腺包膜及包膜以外浸润的肿瘤能进行更准确的分期。     

Radical Prostatectomy or Radiotherapy in High-Risk Prostate Cancer: A Systematic Review and Metaanalysis

BackgroundRadical prostatectomy (RP) is one of the treatment options for localized, high-risk prostate cancer (PC), but it has never been compared with external beam radiotherapy (RT), which is an alternative approach, in a large randomized trial. To compare the outcomes of patients treated with surgery versus RT, we performed a metaanalysis of available studies on this topic.Materials and MethodsWe performed a search of MEDLINE, EMBASE, Web of Science, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL) for randomized or observational studies that investigated overall survival (OS) and PC-specific mortality (PCSM) risks in relation to use of surgery or RT in patients with high-risk PC. Fixed- and random-effect models were fitted to estimate the summary odds ratio (OR). Between-study heterogeneity was tested using χ² statistics and measured using the I² statistic. Publication bias was evaluated using a funnel plot and Egger regression asymmetry test.ResultsSeventeen studies were included (1 randomized and 16 retrospective). RP was associated with improved OS (OR, 0.51; 95% confidence interval [CI], 0.38-0.68; P < .00001), PCSM (OR, 0.56; 95% CI, 0.37-0.85; P = .007), and non-PCSM (OR, 0.53; 95% CI, 0.35-0.8; P = .002) compared with RT. Biochemical relapse-free survival rates were similar to those of RT.ConclusionOverall and cancer-specific mortality rates appear to be better with RP compared with RT in localized, high-risk PC. Surgery is also associated with a 50% decreased risk of non-PCSM compared with RT.     

Population-Based Referrals for Adjuvant Radiotherapy After Radical Prostatectomy in Men With Prostate Cancer: Impact of Randomized Trials

IntroductionTo examine the impact of published randomized controlled trial (RCT) data on referrals for adjuvant radiotherapy (RT) in patients who had high-risk pathologic features after radical prostatectomy (RP).MethodsIn this population-based, retrospective Canadian study, all patients who received a diagnosis of prostate adenocarcinoma and underwent RP from 2003-2008 were identified through the Manitoba Cancer Registry. Manual review of pathology reports was performed, and patients who had high-risk pathologic features of extracapsular extension, seminal vesicle invasion, or positive surgical margins were included. Referrals for adjuvant RT were examined before and after publication of RCT data to determine their influence on practice. Multivariable logistic regression was used to identify factors related to referral.ResultsOf the 1080 identified patients, 546 (50.6%) had ≥ 1 high-risk pathologic feature. Only 78 (14.3%) of the 546 patients were referred for adjuvant RT within 6 months of RP. Year of diagnosis, in relation to the publication of the RCT, was not significantly associated with referral (P = .60). Higher pT stage (P < .0001), Gleason score (P = .035), and increased distance from cancer center (P = .004) were associated with referral.ConclusionIn patients who had high-risk pathologic features after RP, referral rates for adjuvant RT were low and did not increase after presentation of RCT. Men who had higher pT stage, Gleason score, and rural residence were more likely to be referred.     

根治性外放射治疗与根治性前列腺切除术治疗局限性高危前列腺癌的疗效比较

目的 比较根治性外放射治疗（ExRT）与根治性前列腺切除术（RP）治疗局限性高危前列腺癌患者的疗效。方法 回顾性分析诊断为高危前列腺癌（T2b-T4N0M0）并接受ExRT或RP的150例患者。高危前列腺癌的入选标准为PSA≥20 ng/ml或cT3以上或GS≥8。主要研究终点为无生化复发生存期,次要研究终点为无远处转移生存期、癌症特异性生存期及总生存期。结果 88例患者接受了ExRT及雄激素剥夺治疗（ADT）,其余62例患者接受了RP及盆腔淋巴结清扫术（PLND）。两组患者的中位年龄（68.9±5.2 vs. 64.3±6.5岁, P=0.012）及中位随访时间（60.2±32.3 vs. 45.8±25.5月,P=0.005）差异有统计学意义。ExRT组患者生化复发率显著低于RP组患者（23.9% vs. 58.1%, P<0.001）,而无生化复发患者生存期显著延长（96.2±7.4 vs. 38.7±4.6月, P<0.001）。两组无远处转移生存期、癌症特异性生存期及总生存期差异均无统计学意义。结论 与RP相比,接受ExRT治疗的局限性高危前列腺癌患者生化复发率低,无生化复发生存期显著延长。     

BMI在前列腺癌根治术患者中的意义

目的 研究体重指数(body mass index,BMI)在前列腺癌根治术患者中的意义.方法 回顾性分析139例行根治性前列腺切除术患者的年龄、身高、体重、PSA、病理结果,比较包膜内及包膜外组指标的差异,采用logistics回归分析,分析BMI对前列腺癌的影响.结果 139例患者包膜外侵犯共29例,logistics回归分析BMI指数升高(JP=0.013)、tPSA升高(P =0.046)是包膜外侵犯的重要危险因素(P＜0.05).结论 BMI指数升高是前列腺癌包膜外侵犯的重要预测因素,肥胖可能在前列腺癌的进展中起着重要作用.     

Maximum Tumor Diameter and the Risk of Prostate-Specific Antigen Recurrence After Radical Prostatectomy

Introduction/BackgroundThe aim of this study was to investigate whether the MTD could identify men at low risk of PSA recurrence after RP who might not benefit from ART despite other adverse features.Patients and MethodsThe study cohort consisted of 354 men with T1c to T2 prostate cancer diagnosed between September 2001 and December 2008 who underwent RP without adjuvant therapy. Multivariable Cox regression was used to assess the effect of MTD on the risk of PSA recurrence (> 0.1 ng/mL and verified), adjusting for known predictors.ResultsAfter a median follow-up of 4.0 years, 34 men (9.6%) experienced PSA failure. In multivariable analysis, increasing MTD was significantly associated with an increased PSA recurrence risk (hazard ratio, 2.74; 95% confidence interval, 1.23-6.10; P = .01) within the interaction model. Estimates of PSA recurrence-free survival stratified around the median MTD value (1.2 cm) were significantly different in men with a pre-RP PSA > 4 ng/mL (P < .001; 5-year estimate: 74.5% vs. 99.0%) but not in men with PSA ≤ 4 ng/mL (P = .59; 5-year estimate: 89.6% vs. 92.6%), consistent with the significant interaction (P = .004) between PSA and MTD. Moreover, in men with a pre-RP PSA > 4 ng/mL these estimates were significantly different if at least 1 adverse feature (pT3, R1, or Gleason score ≥ 8) was present at RP (P = .01; 5-year estimate: 46.6% vs. 100%) versus none (P = .09; 5-year estimate: 93.4% vs. 98.9%).ConclusionMen with a low MTD (≤ 1.2 cm) appear to be at low risk of PSA recurrence despite adverse features at RP and might not benefit from ART.     

Clinical Utility of a Genomic Classifier in Men Undergoing Radical Prostatectomy: The PRO-IMPACT Trial

PurposeThe optimal management of men with prostate cancer at high risk of recurrence postradical prostatectomy is controversial. The clinical utility of the Decipher test was evaluated prospectively on postoperative treatment decisions and patient-reported outcomes.Methods and MaterialsIn the study, 246 eligible men across 19 centers were enrolled. Patients were dichotomized into those considering adjuvant or salvage radiation therapy (ART or SRT). Participating providers submitted a management recommendation before and after receiving the Decipher test results. Treatment received within 12 months and a validated survey on prostate cancer–related anxiety were collected longitudinally.ResultsPre-Decipher, treatment was recommended for 12% and 40% for the ART and SRT arms, respectively. Post-Decipher, 17% and 30% of treatment recommendations changed in the ART and SRT arms, respectively. Post-Decipher treatment recommendation was administered 78% and 76% of the time in the ART and SRT arms, respectively. Multivariable analysis confirmed that the Decipher score was an independent predictor for change in management for both adjuvant and salvage patients. The number needed to test to change management for one patient was 4. Cancer-specific anxiety decreased among Decipher risk categories in both arms.ConclusionsUse of Decipher postradical prostatectomy test was associated with postoperative treatment decisions. Overall, high Decipher risk was associated with an increase in treatment intensity whereas low risk scores were associated with a decrease in therapy administered independent of clinical and pathologic risk factors.     

Survival Outcomes of Radical Prostatectomy Versus Radiotherapy in Intermediate-Risk Prostate Cancer: A NCDB Study

Background

Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment.

Risk Factors for Clinical Metastasis in Men Undergoing Radical Prostatectomy and Immediate Adjuvant Androgen Deprivation Therapy

Background: Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer(PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate,some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in postprostatectomypatients who received immediate adjuvant ADT. Materials and Methods: We identified 197 patientswith non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvantADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) andcancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Coxproportional hazards model. Median follow-up was 87 months after RP. Results: Nine (4.6%) patients developedclinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score(GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasisonly to para-aortic lymph nodes. On multivariate analyses, pathologic GS ≥9 and regional lymph node metastasis(pN1) were independent predictors of clinical metastasis and pathologic GS ≥9 was an independent predictor ofcancer-specific death. Conclusions: Pathologic GS ≥9 and pN1 were independent predictors of clinical metastasisin post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ≥9 was anindispensable condition for bone metastasis, which may imply that patients with GS ≤8 on adjuvant ADT areunlikely to develop bone metastasis.     

The Effect of Maximum Tumor Diameter by MRI on Disease Control in Intermediate and High-risk Prostate Cancer Patients Treated With Brachytherapy Boost

BackgroundLarger maximum tumor diameter (MTD) has been associated with worse prostate cancer (PCa) outcomes. However, the impact of MTD in PCa treated with external beam radiotherapy and brachytherapy boost (EBRT+BB) remains unknown.Materials and MethodsPatients with PCa treated with EBRT+BB were identified from an institutional database. Clinical data including MTD, age, androgen deprivation therapy (ADT) use, prostate specific antigen (PSA), International Society of Urologic Pathology (ISUP) group, clinical T-stage, and presence of adverse pathology on imaging were retrospectively collected. Multivariable and univariable cox proportional hazards models for biochemical failure (BF) and distant metastasis (DM) were produced with MTD grouped by receiver operating characteristic (ROC) cut-point. Cumulative hazard functions for BF and DM were compared with log-rank test and stratified by ISUP group.ResultsOf 191 patients treated with EBRT+BB, 113 had MTD measurements available. Larger MTD was associated with increased ADT use and seminal vesicle involvement. ROC optimization identified MTD of 24 mm as the optimal cut-point for both BF and DM. MTD was independently associated with both BF (HR 8.61, P = .048, 95% CI 1.02-72.97) and DM (HR 8.55, P = .05, 95% CI 1.00-73.19). In patients with ISUP group 4 to 5 disease, MTD > 24 mm was independently associated with increased risk of DM (HR 10.13, P = .04, 95% CI 1.13-91.12).ConclusionsThis is the first study to evaluate MTD in the setting of EBRT+BB. These results demonstrate that MTD is independently associated with BF and metastasis. This suggests a possible role for MTD in risk assessment models and clinical decision-making for men receiving EBRT+BB.     

Robot-Assisted Radical Prostatectomy for Potential Cancer Control in Patients with Metastatic Prostate Cancer

Recently, cytoreductive prostatectomy for metastatic prostate cancer (mPCa) has been associated with improved oncological outcomes. This study was aimed at evaluating whether robot-assisted radical prostatectomy (RARP) as a form of cytoreductive prostatectomy can improve oncological outcomes in patients with mPCa. We conducted a retrospective study of twelve patients with mPCa who had undergone neoadjuvant therapy followed by RARP. The endpoints were biochemical recurrence-free survival, treatment-free survival, and de novo metastasis-free survival. At the end of the follow-up period, none of the enrolled patients had died from PCa. The 1- and 2-year biochemical recurrence-free survival rates were 83.3% and 66.7%, respectively, and treatment-free survival rates were 75.0% and 56.3%, respectively. One patient developed de novo bone metastases 6.4 months postoperatively, and castration-resistant prostate cancer 8.9 months postoperatively. After RARP, the median duration of recovery of urinary continence was 5.2 months. One patient had severe incontinence (>2 pads/day) 24 months postoperatively. RARP may be a treatment option in patients with mPCa who have achieved a serum prostate-specific antigen level < 0.2 ng/mL, and present without new lesions on imaging.