放射性核素骨显像在前列腺癌骨转移中的研究价值

目的:探讨放射性核素骨显像与血清前列腺特异性抗原(PSA)联合检测在前列腺癌骨转移诊断中的临床意义。方法:对130例前列腺癌患者的PSA检测结果及SPECT骨显像进行回顾性分析。结果:130例前列腺癌患者,骨显像诊断骨转移86例,阳性率为66.2%。在86例骨转移的患者中,发生脊椎转移77例,占77.9%,骨盆转移65例,占75.6%,肋骨转移42例,占48.8%,肩胛骨转移11例,占12.8%,胸骨转移7例,占8.1%,颅骨转移6例,占7%。脊椎和骨盆是前列腺癌骨转移主要涉及的部位。骨显像阳性组和骨显像阴性组PSA均值差异有显著性(P<0.01),PSA<20μg/L的前列腺癌患者发生骨转移的可能性小,PSA≥20μg/L的患者发生骨转移的可能性大。结论:PSA≥20μg/L的前列腺患者应行放射性核素骨显像检查。放射性核素全身骨显像与血清PSA浓度联合检测对于前列腺癌骨转移的临床诊断具有重要的指导意义。     

去势抵抗性前列腺癌患者冷冻消融治疗后中性粒细胞与淋巴细胞比值变化的意义

目的 探讨去势抵抗性前列腺癌(CRPC)患者氩氦冷冻消融术前外周血中性粒细胞与淋巴细胞比值(NLR)变化的意义.方法 收集并分析天津医科大学肿瘤医院33例行氩氦冷冻消融术的CRPC患者的临床病理资料.将可能影响术后总生存期(OS)的因素:年龄、基线前列腺特异抗原(PSA)水平、血红蛋白、白细胞计数、血小板计数、白蛋白、碱性磷酸酶、NLR、血小板与淋巴细胞比值(PLR)、激素敏感时间、是否化疗、有无骨转移、Gleason评分、ECOG评分、PSA有效率进行单因素和多因素分析.结果 本研究共33例患者,平均年龄为69岁(50～82岁),中位生存期为28个月(6～55个月),单因素分析显示:基线PSA水平、碱性磷酸酶、NLR、激素敏感时间、是否化疗、有无骨转移、Gleason评分、PSA有效率是影响CRPC患者冷冻消融术后OS的相关因素(P＜0.05).多因素分析显示:基线PSA水平(P=0.003)、NLR(P=0.009)、Gleason评分(P＜0.001)是CRPC患者冷冻消融术后OS的独立预测因子.结论 NLR可作为CRPC患者行氩氦冷冻消融术的预后指标,NLR升高提示患者预后不良.     

99mTc-PSMA SPECT/CT探测前列腺癌病灶的临床应用价值

目的:探讨^(^(99m))Tc标记前列腺特异性膜抗原(prostate specific membrane antigen,PSMA)小分子抑制剂(HYNIC-Glu-Urea-A,简称^(99m)Tc-PSMA)SPECT/CT显像探测前列腺癌原发灶和转移灶的临床价值。方法:回顾性分析69例(初诊12例、经治57例)前列腺癌患者^(99m)Tc-PSMA SPECT/CT结果,评价全身平面显像结合断层显像检测前列腺癌原发和(或)转移灶的价值,分析^(99m)Tc-PSMA阳性率与前列腺特异性抗原(prostate specific antigen,PSA)水平和Gleason评分的关系。结果:所有69例患者中,6例根治术后PSA<0.2 ng/m L患者为治愈状态,以患者为单位,^(99m)Tc-PSMA阳性率77.8%(49/63)。^(99m)Tc-PSMA阳性患者PSA水平(中位数25.52 ng/m L,范围0.85~3 239 ng/m L)明显高于^(99m)Tc-PSMA阴性患者PSA水平(中位数0.35 ng/m L,范围0.003~9.28 ng/m L)(P<0.001);在初诊和PSA>1.0 ng/m L的复发患者中,阳性率高达97.4%(37/38)。^(99m)Tc-PSMA阳性组患者Gleason评分高于阴性组患者(P<0.001)。结论:对于前列腺癌初诊患者和PSA>1.0 ng/m L的复发患者,^(99m)Tc-PSMA SPECT/CT对原发灶和复发转移灶的探测有较高应用价值,可为临床提供重要的治疗决策依据。     

术前雄激素全阻断治疗对前列腺癌预后的影响

目的 探讨前列腺癌术前雄激素全阻断治疗对患者预后的影响。方法 对51例经耻骨后前列腺癌根治术患者做预后影响因素分析。前列腺癌复发定义为术后前列腺特异性抗原(PSA)值连续2次≥0.5μg/L。应用Cox比例风险模型,分析术前雄激素全阻断治疗对预后的影响及患者年龄、术前PSA、穿刺标本的Gleason评分、切除标本的包膜、切缘、精囊及Gleason评分、淋巴结及患者睾丸是否切除、术后抗雄激素治疗和术后放疗的协同作用。结果 平均随访期为(34.88±22.33)月。将所有因素先放入Cox比例风险模型中,对预后有影响的因素有年龄(P=0.007)、术前雄激素全阻断治疗(P=0.003)、包膜侵犯(P=0.005)、阳性切缘(P=0.000)、穿刺及切除标本Gleason评分(P分别为0.018,0.011)、术前或术后行睾丸切除术(P=0.005)。在Cox比例风险模型中用逐步回归的方法,对预后有意义的因素是年龄(P=0.011)、术前雄激素全阻断治疗(P=0.017)、阳性切缘(P=0.000)、切除标本Gleason评分(P=0.002)、术前或术后行睾丸切除术(P=0.040)。结论 术前雄激素全阻断治疗对前列腺癌患者的预后有明显的益处。     

全身骨显像诊断前列腺癌骨转移与PSA水平及病理分级的相关性研究

目的 探讨核素全身骨显像诊断前列腺癌骨转移与血清前列腺特异性抗原(PSA)水平及前列腺癌病理分级的关系,并研究前列腺癌发生骨转移的规律和特点.方法　对107例前列腺癌患者术前用放免法测定其血清PSA水平,并进行 99Tcm-亚甲基二瞵酸盐全身骨显像,术后对其进行病理分级,分析前列腺癌骨转移与3种方法检查结果的相关性.结...     

前列腺癌骨转移的临床与影像学特点对前列腺癌的诊断价值

目的:分析前列腺癌骨转移的临床与影像学表现,探讨其对前列腺癌的诊断价值.方法:对24例经病理证实的前列腺癌骨转移病例的影像学表现进行了回顾性分析.结果:24例前列腺癌骨转移病例中,多发性骨转移21例,单发性骨转移3例;成骨型骨转移18例,约占75%,混合型骨转移6例,约占25%.转移部位以骨盆、脊椎等中轴骨的多发性成骨转移为主,骨盆16例,胸、腰椎15例.结论:多种影像学检查方法的联合应用有利于发现和诊断前列腺癌的骨转移,对前列腺癌的诊断和治疗具有重要意义.     

胃癌132例核素骨显像结果分析

目的 探讨胃癌患者骨显像结果与不同临床分期和病理类型的关系,以及胃癌骨转移的特点和规律。方法 回顾性分析132例胃癌患者骨显像结果,从病理、临床分期、骨转移灶数目和分布部位进行讨论和分析。结果 132例患者中骨转移21例,占15.9%,其中多发性骨转移19例,占转移患者90.5%;低分化腺癌及未分化癌、黏液腺癌骨转移率分别为15.2%和20%,Ⅲ、Ⅳ期胃癌骨转移率18.4%和26.6%;骨转移的部位以椎体最常见,其次是肋骨、骨盆。结论 胃癌较少转移至骨,一旦发生骨转移,一般转移病灶范围较广泛,已属肿瘤晚期。对分期晚、分化差胃癌患者应定期进行骨核素显像,以早期发现骨转移。     

比较MR扩散加权成像和经直肠超声引导穿刺Gleason评分评估前列腺癌侵袭性的差异

目的 比较DWI ADC值和经直肠超声引导穿刺所得Gleason评分评估前列腺癌侵袭性的作用.方法 回顾性分析51例经穿刺活检确诊为前列腺癌,于1.5 TMR扫描仪上行前列腺DWI检查,并进行了前列腺癌根治术的患者资料.以前列腺癌根治术标本为参考,测量前列腺癌灶的ADC值,采用Pearson相关分析检验癌灶ADC值与前列腺癌根治术标本Gleason评分的相关性,以及穿刺活检所得Gleason评分与前列腺癌根治术标本Gleason评分的相关性,采用ROC曲线分析确定癌灶ADC值和穿刺活检所得Gleason评分区分前列腺低级别癌和中高级别癌的效能.结果 前列腺穿刺活检评估前列腺癌根治术标本Gleason评分的准确率为41.2％ (21/51),11.8％ (6/51)患者Gleason评分被高估,47.0％ (24/51)患者GS被低估.51例患者前列腺癌灶的ADC值平均为(0.974±0.194)×10-3 mm2/s,35例中高级别前列腺癌平均ADC值为(0.907±0.160)×10-3 mm2/s,16例低级别前列腺癌平均ADC值为(1.121±0.185)×10-3 mm2/s.前列腺癌灶ADC值与前列腺癌根治术标本Gleason评分存在负相关性(r=-0.761,P＜0.01),而穿刺活检所得Gleason评分与前列腺癌根治术标本Gleason评分不存在相关性(r=0.187,P=0.189).ADC值和穿刺活检所得Gleason 评分区分前列腺低级别癌和中高级别癌的ROC曲线下面积分别为0.827和0.689.结论 前列腺癌灶的ADC值预测前列腺癌侵袭性优于穿刺活检所得Gleason评分.     

超声引导下~(125)I粒子植入治疗前列腺癌术后血清PSA变化与疗效评估

目的探讨经直肠超声引导下~(125)I放射性粒子植入治疗前列腺癌患者术后PSA变化及影响治疗效果的危险因素。方法 2010年1月~2015年12月经直肠超声引导下~(125)I放射性粒子植入治疗的前列腺癌患者70例,年龄52~81岁,平均(67.2±0.7)岁,术前均经病理证实为前列腺癌。术前PSA 5.68~35.43ng/ml,平均(14.42±0.73)ng/ml,临床分期T1c~T2b,Gleason评分4~7分,随访3~60个月,依随访结果分三组:A组:良性反弹组,32例(45.7%),B组:生化复发组,12例(17.1%)。C组:疗效稳定组,26例(37.1%)。结果 A组PSA降至最低值后开始升高时间发生在术后(16.5±1.3)月,且65.6%(21/32)出现于14~27周;B组PSA降至最低值后开始升高时间发生在术后(29.7±2.2)月;C组PSA降至最低值时后长期保持稳定。治疗时患者年龄是良性反弹(A组)的危险因素(P=0.0025,P0.01)。A组和B组在PSA降至最低值开始升高时间参数中差异具有统计学意义(P0.01)。结论超声引导下~(125)I放射性粒子植入治疗前列腺癌术后监测血PSA变化有助于临床对治疗效果的评估。     

超声造影早期预测前列腺癌经内分泌治疗后进展为去势抵抗性前列腺癌的价值

【摘要】目的:探讨超声造影（CEUS）联合常见影响因素早期预测前列腺癌（PCa）患者经内分泌治疗后2年内进展为去势抵抗性前列腺癌(CRPC)的价值。方法:选择接受内分泌治疗的92例中晚期PCa患者作为研究对象,治疗前均接受前列腺特异抗原（PSA）水平测定、CEUS检查以及病理分级。内分泌治疗后进行2年随访,随访期间进展为CRPC的PCa患者纳入预后不良组,其余患者纳入预后良好组。比较两组患者的临床指标及CEUS参数,并利用多因素COX回归进行筛选,获得PCa患者进展为CRPC的影响因素。利用受试者工作特征（ROC)曲线评估潜在影响因素早期预测CRPC的价值,并分析各影响因素的联合模型早期预测CRPC的准确性。结果:2年随访期内CRPC的发生率为63.04%(58/92)。多因素COX回归分析结果显示,T分期（P=0.021）、M分期（P=0.024）、Gleason评分（P=0.018）、治疗前PSA（P=0.004）、AUCTIC（P=0.003）是影响PCa进展为CRPC的独立影响因素。ROC曲线分析结果显示各指标预测CRPC的准确性均不高（AUC均<0.9）,其中AUCTIC的准确性最高（AUC=0.818）。T分期、M分期、Gleason评分、治疗前PSA的联合可以提高早期预测CRPC的准确性,但准确性仍然不够高（AUC=0.834<0.9）。结合AUCTIC的联合预测模型能够在早期准确预测PCa患者进展为CRPC的概率（AUC=0.910）,拟合方程为Logit (P)=-1.259+0.667×M分期+ 0.420×T分期+0.164×Gleason 评分+0.021×治疗前PSA +0.007×AUCTIC。结论:Gleason评分、T分期、M期、治疗前PSA以及AUCTIC是早期预测老年PCa患者进展为CRPC的独立影响因素,利用超声造影指标AUCTIC结合常规临床指标建立的预测模型可以早期准确预测PCa患者进展为CRPC的概率。     

Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer

PURPOSE: To evaluate 10-year survival rates after prostate brachytherapy and to assess the relative importance of pretreatment prostate-specific antigen (PSA) and Gleason score in predicting cancer death. MATERIALS AND METHODS: A retrospective review was performed on all patients treated with permanent brachytherapy for stage T1 or T2 primary prostate cancer at a single institution from December 1988 through June 30, 1998. The study cohort consisted of 1266 patients with a median follow-up of 4.1 years and a maximum of 12.6 years. Actuarial survival and cause-specific survival rates were calculated as the primary endpoints, and compared at 5 and 10 years. Groups studied consist of PSAor=10 as well as Gleason 2-4, 5-6, and 7-10. Multivariate and univariate analysis were performed looking at stage, grade, PSA, and risk group as variables. RESULTS: The median age at the time of treatment was 73 years and at the time of analysis 603 patients were known to be alive. Overall survival is 38% at 10 years, however most deaths were unrelated to prostate cancer. Cause specific survival at 5 and 10 years is 98% and 87%. Both grade (>or=Gleason 7) and PSA (>or=10 ng/ml) predict adversely for cancer death within 10 years. Patients with low grade or PSA at presentation reveal prostate cancer-specific survival of 91% and 98%, respectively. By contrast, men with high grade or high PSA presentation have survival of 66% and 69% at 10 years. In multivariate analysis, the presence of one of these adverse features carries a hazard ratio of cancer death of 4.7 and 6.4, while the presence of multiple risk factors places patients in an unfavorable risk group with a hazard ratio of 27. CONCLUSIONS: Biochemical disease-free survival is a useful tool to assess prostate cancer treatments and is predicted based on established pretreatment risk groups. Long-term cancer-specific survival is ultimately a more important endpoint. Brachytherapy is reported here to be an excellent therapeutic alternative for selected early stage patients with prostate cancer. This is based on 10-year cause specific survival, which may also be predicted by stage, grade, PSA, and risk group. Of these, the risk group remains the most powerful parameter to identify those patients at highest risk of biochemical failure and death from prostate cancer.     

Higher scrotal uptake ratio of 99mTc-MDP on bone scans in newly diagnosed prostate cancer: a reliable indicator of pelvic node metastasis

Objective

Pelvic lymph node dissection (PLND) is the gold standard procedure for nodal staging in prostate cancer (PC) but less commonly used due to its invasiveness. More commonly computerized tomography (CT) and magnetic resonance imaging (MRI) are used although these have limited sensitivities and specificities. The aim of this study was to find out the correlation between higher scrotal uptake ratio (SUR) of ^99mTc-methylene diphosphonate (MDP) on bone scan and pelvic node metastasis in patients with PC at high risk for nodal metastasis.

Methods

This was a retrospective study which included 68 biopsy proven newly diagnosed PC patients who had bone scan from January 2008 till January 2012. MRI of the pelvis, prostate specific antigen (PSA) and Gleason??s score were available in all patients. Whole body bone scan was performed in all patients and SUR was calculated by dividing mean counts over scrotum and soft tissue over lateral aspect of right thigh. PLND was carried out within 2?C3?weeks of MRI study in these patients.

Results

Mean age of studied males was 71?±?07?years with a mean PSA level of 65?±?162?ng/ml. Prostate biopsy revealed adenocarcinoma in all patients with mean Gleason??s score 7?±?1. Mean SUR was 2.786?±?0.496. MRI was positive for pelvic lymphadenopathy in 32/68 (47?%). PLND revealed evidence of nodal metastasis in 16/68 (24?%) patients. Receiver operating characteristic analysis revealed good diagnostic strength of SUR for nodal metastasis with a cut off value of >2.99 with an area under curve (AUC) 0.708 (95?% CI 0.533?C0.847, p value <0.05) and a mean sensitivity of 68.75?% and mean specificity of 80?%. Diagnostic strength of MRI for nodal metastasis was found to be low (AUC 0.566, 95?% CI 0.047?C0.657, non-significant p value). No significant correlation was found between SUR and PSA in nodes positive and nodes negative patients.

Conclusion

We conclude that in newly diagnosed PC patients, higher SUR on bone scan has a high diagnostic accuracy for pelvic node metastasis. Furthermore, a bone scan with a SUR <2.99 and negative for bone metastasis can stratify newly diagnosed PC patients as low risk.     

The value of a baseline bone scan in patients with newly diagnosed prostate cancer.

PURPOSE: This study evaluated the role of bone scans in managing newly diagnosed, untreated prostate cancer. METHODS: Two hundred seventy consecutive staging bone scans in patients (mean age, 69 years) with newly diagnosed prostate cancer who had serum prostate-specific antigen (PSA) determinations and biopsies between January 1995 and October 1997 were evaluated retrospectively. RESULTS: The bone scans were positive for metastatic bone disease in 24 patients and negative in 246. Serum PSA levels, the number of positive biopsy cores, the extent of tumor in the prostate gland, and Gleason scores were all significantly correlated with scintigraphic bone metastases (P < 0.0001 for each). Of the 177 patients with PSA levels less than 10 ng/ml, three had bone metastases. Bone metastases were found in 2 of 34 patients with PSA levels of 10.1 to 20 ng/ml, in 3 of 29 patients with PSA values of 20.1 to 50 ng/ml, and in 16 of 30 patients with PSA levels greater than 50.1 ng/ml. Only one patient had a bone metastasis when the prostate cancer involved fewer than 2 biopsy cores (1 of 135) or when disease was confined to one lobe (1 of 131), but the incidence increased significantly when the malignancy involved three or more biopsy cores (20 of 114) or disease was present in both prostate lobes (20 of 118). Four of 160 patients with Gleason scores less than 6 had bone metastases, whereas 20 of 110 patients with Gleason scores greater than 7 had bone metastases. CONCLUSIONS: The likelihood of bone metastases is low in patients with newly diagnosed, untreated prostate cancer when the initial PSA level was less than 10 ng/ml, the number of positive biopsy cores was less than 2, tumor was confined to one lobe, or the Gleason score was less than 6. However, none of these criteria can be used to exclude metastatic bone disease. A baseline bone scan is an important staging procedure and should be obtained to provide maximum data for clinical management of the disease.     

Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients

Objectives

The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA <20 in well–moderately differentiated tumours.

Methods

We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made.

Results

Of 672 patients aged 39–93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p<0.01. None of the 357 patients with a PSA level of <20 and a Gleason score of <8 had a positive bone scan.

Conclusion

Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of <20 and a Gleason score of <8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.Prostate cancer is currently the most common malignancy diagnosed in men in the UK [1] and bone is the second most common site of metastasis [2]. Bone metastases are present in up to 14% of patients at presentation [3] and in 80–85% of those who die of the disease [4], and they therefore affect morbidity, reflect prognosis and significantly influence decisions with regard to patient management.Sensitivity of planar bone scan for the detection of bone metastases is 72–77% in adults [5,6] and is currently the investigation of choice. However, it lacks diagnostic specificity, with indeterminate results often prompting the need for further imaging.Prostate-specific antigen (PSA) level is an established prognostic marker that correlates with bone scan positivity, and various studies demonstrate a low risk of a positive bone scan in newly diagnosed patients with a low PSA level [3,4,7-13]. Gleason score is also of important prognostic significance and has been shown to be an independent predictor of bone scan results on multivariate analysis [4,7,12,14]. There is still a lack of consensus, however, on the referral criteria for bone scan in low-risk patients, with different authors supporting various cut-off levels of PSA, with some including Gleason score and clinical stage. The European Association of Urology (EAU) guidelines, updated in March 2009, recommend that staging bone scan may not be indicated in patients with a PSA level of <20 with moderately to well-differentiated tumours in the absence of bony symptoms [15], while the American Urological Association and American Joint Committee on Cancer (AJCC) both recommend that staging bone scan is indicated in patients with a Gleason score of >7 or a PSA level of >20 prior to treatment [14].Despite this, there remains a large demand for isotope bone scanning in patients with a new diagnosis of prostate cancer regardless of risk stratification based on these prognostic tools.The purpose of the current study was to correlate PSA levels and Gleason scores with bone scan results in patients with newly diagnosed prostate cancer, with the aim of identifying a subgroup of patients who did not require staging bone scan, and assess the feasibility and safety of implementing EAU guidelines.     

Expression of Ku70 predicts results of radiotherapy in prostate cancer

Background and purpose

Therapeutic strategy for prostate cancer is decided according to T stage, Gleason score, and prostate-specific antigen (PSA) level. These clinical factors are not accurate enough to predict individual risk of local failure of prostate cancer after radiotherapy. Parameters involved with radiosensitivity are required to improve the predictive capability for local relapse.

Patients and methods

We analyzed 58 patients with localized adenocarcinoma of the prostate between August 2007 and October 2010 treated with 76 Gy of intensity-modulated radiotherapy (IMRT) as a discovery cohort and 42 patients between March 2001 and May 2007 treated with three-dimensional conformal radiotherapy (3D-CRT) as a validation cohort. Immunohistochemical examination for proteins involved in nonhomologous end-joining was performed using biopsy specimens.

Results

Ku70 expression was not correlated with various clinical parameters, such as the Gleason score and D’amico risk classification, indicating that Ku70 expression was an independent prognostic factor. The predictive value for PSA relapse was markedly improved after the combination of Gleason score and Ku70 expression, as compared with Gleason score alone. In patients treated with radiotherapy and androgen deprivation therapy (ADT), no relapses were observed in patients with Gleason score ≤7 or low Ku70 expression. In contrast, patients with Gleason score ≥8 and high Ku70 expression had high PSA relapse rates. In the validation cohort, similar results were obtained.

Conclusion

Treatment with 76 Gy and ADT can be effective for patients with Gleason score ≤7 or low Ku70 expression, but is not enough for patients with Gleason score ≥8 and high Ku70 expression and, thus, require other treatment approaches.

     

Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients

Purpose

To report outcomes of patients undergoing low-dose-rate (LDR) brachytherapy and investigate factors associated with biochemical failure and survival.

MRI与骨扫描诊断前列腺癌骨转移的比较

目的 通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断,以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法 回顾性分析2011年1月-2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁,平均年龄（73±7.98）岁,分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（ＮＰＶ）。结果 54例病人诊断为骨转移（成骨性骨转移48例,混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA）>50 ng/mL,而92%（182/19８）的前列腺癌无骨转移病人的PSA<50 ng/mL。MRI诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为85.1%、100%、96.8%、100%、96.1%;全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高,骨扫描的敏感度较高。MRI与骨扫描可以实现优势互补,利于前列腺癌的准确临床分期。     

Prostate specific antigen level and Gleason score in predicting the stage of newly diagnosed prostate cancer.

The purpose of this study was to determine the utility of prostate specific antigen (PSA) level and Gleason score in the prediction of disease stage in men with newly diagnosed prostate cancer. 102 consecutive men, newly diagnosed with prostate cancer and candidates for radical therapy, underwent contrast enhanced pelvic CT and skeletal scintigraphy. Staging examinations used the TNM classification and were reported prospectively with the radiologist blinded to the patient's Gleason score and level of PSA. Lymph node metastasis was confirmed by CT guided biopsy, lymphadenectomy or response to therapy in some cases of massive disease. There were significant differences between the mean PSA values of 18 men with and 84 men without skeletal metastases (p = 0.01) and between men with locally confined and non-confined disease (p = 0.02). There was no difference between PSA values of 13 men with and 89 men without lymph node metastasis (p = 0.9). Only one man with CT evidence of nodal metastasis (N + ve) had a PSA value below 20 ng ml-1. Two men with Gleason scores below 6 were N + ve and both had PSA values over 20 ng ml-1. One man with skeletal metastasis had a PSA value below 20 ng ml-1 but had bone pain. For this study group if only those men with PSA values over 20 ng ml-1 had been examined, sensitivity for lymphatic and skeletal metastasis would have been 92%. Using this threshold about one-third would have been spared imaging investigation. In conclusion, pelvic CT and skeletal scintigraphy are unlikely to show metastatic disease in a man newly diagnosed with prostate cancer who has no suggestive clinical features, a PSA level below 20 ng ml-1 and a Gleason score below 6.     

Australian prostate-specific antigen outcome and toxicity following radiation therapy for localized prostate cancer

The objective of the present study was to examine prostate-specific antigen relapse free survival (PSA-RFS) and morbidity following 'conventional' radical radiation therapy for prostate cancer in two Australian regional treatment services. Four hundred and eighty men with clinically localized prostate cancer were treated between 1993 and 1997 at Liverpool and Westmead Hospitals using a standardized 4-field, CT-planned radiotherapy technique. Principal endpoints were PSA-RFS (American Society for Therapeutic Radiology and Oncology guidelines definition) and late rectal and urinary morbidity (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria). The median follow up of patients from the end of RT was 55 months. Prospectively, they were divided into three prognostic categories: (i) high risk T3 or 4 and/or PSA > 20 ng/mL and/or Gleason score 8-10 (40% of cohort); (ii) intermediate risk T1 or 2 and PSA 10-20 ng/mL and/or Gleason score 7 (33% of cohort); and (iii) low risk T1 or 2 and PSA < 10 ng/mL and Gleason score < 6 (27% of cohort). The 5-year actuarial PSA-RFS was 53% for the whole patient group. The 4-year rates were 32, 56 and 75% for high, intermediate and low risk groups, respectively. On multivariate analysis, T-stage, Gleason score, pre-RT-PSA were strong independent predictors of PSA-defined outcome. Late (grade 2) rectal and urinary morbidity occurred at some point in time in the post-RT period in 8.0 and 5.8% of patients, respectively. These results confirm that low Gleason score, low T stage, presenting PSA < 10 ng/mL and nadir < 1 ng/mL remain the strongest predictors of a good outcome. Long-term toxicity was very acceptable. However, further improvement in outcome is desirable, and with the adoption of new technology allowing escalation of radiotherapy doses such an expectation might be achieved.