腹腔镜前列腺癌根治术后神经侵犯阳性的影响因素分析

目的 分析腹腔镜前列腺癌根治术后病理标本神经侵犯阳性的影响因素。方法 回顾2018年1月至2023年3月于川北医学院附属医院泌尿外科行腹腔镜前列腺癌根治术的104例患者临床资料,收集患者年龄、吸烟史、饮酒史、术前总前列腺特异性抗原（total prostate-specific antigen,TPSA）、术前游离前列腺特异性抗原（free prostate-specific antigen,FPSA）/总前列腺特异性抗原比值（F/T比值）、术后病理Gleason评分、包膜侵犯情况、神经侵犯情况、切缘情况、精囊侵犯情况、病理T分期,根据术后病理结果分为神经侵犯阳性组和神经侵犯阴性组。比较2组患者的年龄、吸烟史、饮酒史、术前TPSA、术前F/T比值、术后病理Gleason评分、包膜侵犯情况、切缘情况、精囊侵犯情况、病理T分期,采用卡方检验和多因素logistic回归分析分别对变量进行分析,探寻神经侵犯阳性的影响因素。结果 本研究总共纳入104例患者,其中神经侵犯阳性患者30例,约占28.85%,神经侵犯阴性患者74例,约占71.15%。所有患者术后病理结果均证实为前列腺癌。单因素分析结果显示,患者年龄、F/T比值、Gleason评分、包膜侵犯、切缘阳性、精囊侵犯、病理T分期比较差异有统计学意义（P<0.05）。吸烟史、饮酒史、术前TPSA比较差异无统计学意义（P>0.05）。将具有统计学意义的指标纳入多因素logistic回归分析,结果显示年龄<70岁和切缘阳性是腹腔镜前列腺癌根治术后神经侵犯阳性的独立影响因素（P<0.05）。结论 年龄、F/T比值、Gleason评分、包膜侵犯、切缘阳性、精囊侵犯、病理T分期与腹腔镜前列腺癌根治术后神经侵犯阳性存在显著相关。其中,年龄<70岁和切缘阳性是腹腔镜前列腺癌根治术后神经侵犯阳性的独立危险因素。     

前列腺穿刺活检在前列腺癌诊断及分期中的临床意义

目的：探讨B超引导下经直肠前列腺十三点穿刺活检对前列腺癌诊断及分期的临床价值。方法；142例符合穿刺标准的患者，在B超引导下经直肠行前列腺十三点穿刺活检后进行病检，观察穿刺活检病理结果、病理分期和Gleason评分。结果：142例行前列腺穿刺的患者中有35例（24．65％）病理确诊为前列腺癌，其中A期0例；B期1例，Gleason评分3分，阳性针数2针；C期16例．Gleason评分平均5．5分．阳性针数平均4．5针；D期18例，Gleason评分平均6．6分，阳性针数平均7．6针。结论：B超引导经直肠前列腺十三点穿刺活检法对前列腺癌诊断及分期有重要意义。     

穿刺活检单针阳性的前列腺癌手术策略选择及经验总结

目的: 分析穿刺活检单针阳性的前列腺癌患者行前列腺癌根治性切除术后的临床病理特征,以协助选择手术策略。方法: 回顾性分析2010年1月至2018年12月北京大学第三医院泌尿外科收治的经直肠前列腺系统穿刺活检单针阳性并且接受前列腺癌根治术的患者共计53例,患者年龄(69.7±6.9)岁(54~81岁)。穿刺前前列腺特异抗原(prostate specific antigen,PSA)为(9.70±5.24) μg/L(1.69~25.69 μg/L),前列腺体积为(50.70±28.39) mL(12.41~171.92 mL),穿刺Gleason评分6分、7分和≥8分者分别为39例(73.6%)、11例(20.8%)和3例(5.7%),临床分期T1期、T2期和T3期者分别为6例(11.3%)、44例(83.0%)和3例(5.7%)。按年龄、术前PSA水平、穿刺Gleason评分、单针肿瘤占穿刺组织百分比和临床分期等因素进行分组,比较各组患者的临床病理特征差异。结果: 术后Gleason评分6分、7分和≥8分者分别为 20例(37.7%)、21例(39.6%)和10例(18.9%),另有2例(3.8%)为pT0;病理分期T0期、T2a期、T2b期、T2c期和T3期者分别为2例(3.8%)、9例(17.0%)、2例(3.8%)、29例(54.7%)和11例(20.8%);11例(20.8%)手术切缘阳性,10例前列腺包膜外侵犯(18.9%),1例(1.9%)精囊侵犯。术后肿瘤呈多灶状分布42例(79.2%),双侧分布37例(69.8%)。与术前穿刺Gleason评分比较,术后Gleason评分下降3例(5.7%), 不变28例(52.8%),升级20例(37.7%),其中有2例(3.8%)为pT0;与临床分期比较,术后病理分期下降2例(3.8%),不变10例(18.9%),升级41例(77.4%)。根据术后病理分为微灶癌组(n=8)和非微灶癌组(n=45), 经比较,两组单针肿瘤占穿刺组织百分比(≤5%)差异有统计学意义(P=0.014),而年龄、前列腺体积、术前前列腺特异抗原密度(prostate special antigen density,PSAD)和术前穿刺Gleason评分差异无统计学意义(P>0.05);通过穿刺活检判断癌灶位于尖部的方法,假阴性率41.4%(12/29),假阳性率 50.0%(12/24)。实际清扫淋巴结和保留性神经的病例,与根据术后病理再次判断方案选择时存在统计学差异(P<0.05)。结论: 单针肿瘤占穿刺组织百分比≤5%是前列腺微灶癌的预测因素。37.7%病例发生病理分级升级和77.4%病例发生病理分期升级,选择手术方案(如性神经保护、淋巴结清扫、尖部的处理等)时,需要综合分析肿瘤危险度分层、列线图预测因素、多参数磁共振成像以及术中情况等多因素。     

穿刺活检单针阳性的前列腺癌手术策略选择及经验总结

目的: 分析穿刺活检单针阳性的前列腺癌患者行前列腺癌根治性切除术后的临床病理特征,以协助选择手术策略。方法: 回顾性分析2010年1月至2018年12月北京大学第三医院泌尿外科收治的经直肠前列腺系统穿刺活检单针阳性并且接受前列腺癌根治术的患者共计53例,患者年龄(69.7±6.9)岁(54~81岁)。穿刺前前列腺特异抗原(prostate specific antigen,PSA)为(9.70±5.24) μg/L(1.69~25.69 μg/L),前列腺体积为(50.70±28.39) mL(12.41~171.92 mL),穿刺Gleason评分6分、7分和≥8分者分别为39例(73.6%)、11例(20.8%)和3例(5.7%),临床分期T1期、T2期和T3期者分别为6例(11.3%)、44例(83.0%)和3例(5.7%)。按年龄、术前PSA水平、穿刺Gleason评分、单针肿瘤占穿刺组织百分比和临床分期等因素进行分组,比较各组患者的临床病理特征差异。结果: 术后Gleason评分6分、7分和≥8分者分别为 20例(37.7%)、21例(39.6%)和10例(18.9%),另有2例(3.8%)为pT0;病理分期T0期、T2a期、T2b期、T2c期和T3期者分别为2例(3.8%)、9例(17.0%)、2例(3.8%)、29例(54.7%)和11例(20.8%);11例(20.8%)手术切缘阳性,10例前列腺包膜外侵犯(18.9%),1例(1.9%)精囊侵犯。术后肿瘤呈多灶状分布42例(79.2%),双侧分布37例(69.8%)。与术前穿刺Gleason评分比较,术后Gleason评分下降3例(5.7%), 不变28例(52.8%),升级20例(37.7%),其中有2例(3.8%)为pT0;与临床分期比较,术后病理分期下降2例(3.8%),不变10例(18.9%),升级41例(77.4%)。根据术后病理分为微灶癌组(n=8)和非微灶癌组(n=45), 经比较,两组单针肿瘤占穿刺组织百分比(≤5%)差异有统计学意义(P=0.014),而年龄、前列腺体积、术前前列腺特异抗原密度(prostate special antigen density,PSAD)和术前穿刺Gleason评分差异无统计学意义(P>0.05);通过穿刺活检判断癌灶位于尖部的方法,假阴性率41.4%(12/29),假阳性率 50.0%(12/24)。实际清扫淋巴结和保留性神经的病例,与根据术后病理再次判断方案选择时存在统计学差异(P<0.05)。结论: 单针肿瘤占穿刺组织百分比≤5%是前列腺微灶癌的预测因素。37.7%病例发生病理分级升级和77.4%病例发生病理分期升级,选择手术方案(如性神经保护、淋巴结清扫、尖部的处理等)时,需要综合分析肿瘤危险度分层、列线图预测因素、多参数磁共振成像以及术中情况等多因素。     

Oncol2012: Are Partin tables suitable for Chinese patients with prostate cancer?

目的：验证来源于美国的3个版本的Partin表预测中国的前列腺癌患者的术后前列腺癌病理分期的准确性,以及哪个版本的Partin表预测准确性最高,评定Partin表能否适用于中国前列腺癌患者。方法：回顾2000年6月-2012年5月行前列腺癌根治术的203例前列腺癌患者资料,根据患者的PSA值、前列腺穿刺标本的Gleason评分及临床分期,通过3个Partin表预测病人肿瘤包膜局限、包膜侵犯、精囊侵犯及盆腔淋巴结转移这四种病理情况的概率,再与术后病理检查的实际结果进行对比,利用受试者工作曲线下面积（AUC）来评估3个版本的Partin表预测中国前列腺癌患者术后病理分期的准确性,AUC>0.7被认为有良好的预测准确性。结果：和构建3个版本的partin表的基础样本人群相比,本组病例的血清PSA水平、Gleason评分明显偏高,临床分期偏晚,尤其是PSA值,差别很大。1997版本、2001版本及2007版本的Partin表预测本组病例包膜局限的ROC曲线的AUC分别是0.876、0.786、0.728,包膜侵犯的AUC分别是0.525、0.612、0.604,精囊侵犯的AUC分别是0.877、0.648、0.817,盆腔淋巴结转移的AUC分别是0.806、0.758、0.732。结论：除了2001版在预测精囊侵犯方面稍差外3个版本的Partin表预测包膜局限、精囊侵犯及淋巴结转移的准确性都不错,但是在预测包膜侵犯方面均不理想,这可能和国内病理部门处理前列腺癌标本不够规范有关。1997版的Partin表在预测包膜局限显著好于2007,预测精囊侵犯显著好于2001版。相对旧的版本,2007版本Partin表并没有表现出优越性。     

前列腺癌患者根治术后病理Gleason评分升高预测因素研究

目的 探讨经直肠前列腺穿刺活检的中低危前列腺癌患者术后发生病理Gleason评分升高的预测因素.方法 收集2005年1月至2016年5月于我院泌尿外科接受前列腺穿刺活检并行前列腺癌根治手术的123例中低危前列腺癌患者的临床资料,回顾性分析术后发生Gleason评分升高与患者年龄、术前血清总前列腺特异抗原(total prostate specific antigen,tPSA)、术前血清游离PSA(fPSA)/tPSA、前列腺体积、前列腺特异性抗原密度(PSAD)、穿刺阳性针数比、切缘阳性率、穿刺评分等级、临床分期等的关系,进一步分析其预测价值.结果 123例患者中经直肠超声(transrectal ultrasonography,TRUS)引导下前列腺穿刺活检病理Gleason评分与前列腺癌根治术后病理Gleason评分保持一致66例(53.7％),评分下降10例(8.1％),评分升高47例(38.2％).前列腺体积、PSAD及穿刺活检病理Gleason评分等级与术后发生病理Gleason评分升高有关(P＜0.05).进一步Logistic回归分析结果显示仅PSAD(P =0.01)与穿刺活检病理Gleason评分等级(P=0.03)是前列腺癌根治术后病理Gleason评分升高的独立预测因子.应用受试者工作特征(receiver operating characteristic,ROC)曲线分析得出:前列腺穿刺活检病理Gleason评分等级=7的患者,PSAD＞ 0.282 ng/(mL·g)时,根治术后发生具有临床意义的Gleason评分升高的可能性大(敏感性78.2％,特异性70.4％);而前列腺穿刺活检病理Gleason评分等级≤6的患者,PSAD＞0.265 ng/(mL·g)时,根治术后发生具有临床意义的Gleason评分升高的可能性大(敏感性77.1％,特异性68.0％).结论 PSAD与穿刺评分等级是根治术后病理Gleason评分升高的独立预测因子.PSAD与前列腺癌患者术后发生病理Gleason评分升高密切相关.     

前列腺特异性抗原相关变数与前列腺癌Gleason评分及临床分期的关系

目的:探讨前列腺特异性抗原(PSA)相关变数与前列腺癌病理分级及临床分期的关系。方法:回顾性分析125例经穿刺活检病理证实为前列腺癌患者的临床资料,采用Spearman相关分析探讨游离PSA(FPSA)、FPSA比率(F/TPSA)、PSA密度(PSAD)与Gleason评分及临床分期的关系。结果:FPSA与前列腺癌Gleason评分呈正相关(rS=0.499,P<0.001),与临床分期呈负相关(rS=-0.300,P<0.001);PSAD与前列腺癌Gleason评分呈正相关(rS=0.616,P<0.001),与临床分期无相关性(rS=-0.128,P=0.155);F/TPSA与前列腺癌Gleason评分呈弱相关(rS=0.182,P=0.042),与临床分期呈负相关(rS=-0.417,P<0.001)。结论:FPSA可作为前列腺癌病理分级和临床分期的参考指标;而PSAD可作为前列腺癌病理分级的参考指标,F/TPSA可作为前列腺癌临床分期的参考指标。     

直肠指检与前列腺穿刺活检结果相关指标关系的研究

目的:探讨直肠指检(DRE)与前列腺穿刺活检相关指标之间的关系,重新评价直肠指检的意义及必要性。方法:选取天津医科大学第二医院的前列腺穿刺活检患者,统计其DRE结果与前列腺穿刺活检的结果,同时收集年龄、前列腺特异性抗原(PSA)、前列腺体积(PV)、PSA密度(PSAD)及前列腺癌患者的Gleason评分、骨扫描、局部侵犯神经情况,分析其与直肠指检之间的意义。结果:总计457例患者纳入研究,其中穿刺阳性患者223例,阴性患者234例;DRE阳性患者99例,阴性患者358例。良性与恶性患者的DRE检查结果比较,差异有统计学意义(P0.001)。DRE阳性和阴性患者的Gleason评分、骨转移、PSA、PSAD、阳性针数占比比较,差异均有统计学意义(P=0.045、P=0.044、P0.001、P0.001、P=0.021);而年龄、f/t PSA、前列腺体积、局部神经侵犯方面比较,差异均无统计学意义(P=0.772、0.316、0.322、0.521)。结论:直肠指检仍然是前列腺癌筛查的重要手段,其阳性与前列腺癌恶性程度有显著的相关性,临床医师在依赖其他先进检查的同时,也应对传统的直肠指检保持重视。     

认知靶向融合穿刺病理联合mpMRI参数预测前列腺癌长期生化复发的随访研究

目的确定生化复发相关的前列腺癌根治术前特征,寻找前列腺癌远期生化复发风险预测方法。方法回 顾性分析2009年—2018年于复旦大学附属华东医院接受前列腺癌根治手术的210例患者临床资料,63例患者出现术后生化复发,作为生化复发组,其余147例未出现生化复发的患者作为对照组,中位随访时间71个月。比较2组患者的一般情况、磁共振结果及病理学特征。采用Cox回归模型分析生化复发的危险因素以及构建模型,使用Kaplan-Meier法分析该模型在术前预测前列腺癌患者生化复发的诊断效能。结果生化复发组MRI病灶长径[（16±8） mm vs （12±5） mm]、MRI下包膜外侵犯率（42.9% vs 20.4%）、MRI下精囊侵犯率（23.8% vs 5.4%）、PI-RADS评分、活检国际泌尿外科病理协会(International Society of Urological Pathology, ISUP)分级分组均高于对照组（P<0.05）,Cox多因素分析筛选出MRI病灶长径、MRI下精囊侵犯、ISUP分级分组为前列腺癌患者生化复发的独立危险因素。基于融合穿刺的术前特征包括磁共振最大病灶长径>23 mm、术前靶向穿刺ISUP分级分组≥3分和磁共振精囊侵犯,建立风险预测分层模型,精准预测了前列腺癌根治术后生化复发（AUC=0.692,P<0.001）,对于传统的d’Amico风险评分在同一队列中检验有更大的曲线下面积。结论生化复发与术前MRI病灶长径、包膜外侵犯、精囊侵犯、PI-RADS评分和ISUP分级分组有关,认知靶向融合穿刺病理联合mpMRI参数能够用于评估前列腺癌患者术后长期生化复发风险,为前列腺癌治疗提供参考。     

不同版本Partin表预测国人前列腺癌病理分期准确性比较

目的 验证1997、2001、2007、2012版Partin表对预测国人前列腺癌患者病理分期的准确性.方法 回顾性分析我科2005年2月至2013年12月163例前列腺癌根治手术患者资料,4种Partin表分析应用患者术前PSA、穿刺Gleason评分及临床分期等资料,依据不同预测表要求分别查出对应的肿瘤器官局限、包膜外侵犯、精囊侵犯、淋巴结转移的概率,运用受试者工作曲线(ROC)评价并比较各版本的预测准确性.结果 1997、2001、2007、2012 4种Partin表预测的器官局限AUC值分别为0.749、0.725、0.709和0.665;包膜外侵犯的AUC值分别为0.503、0.461、0.504和0.607,精囊侵犯的AUC值分别为0.749、0.603、0.627和0.730,淋巴结转移的AUC分别为0.718、0.698、0.632和0.797.结论 1997、2001及2012版Partin表预测国人局限性前列腺癌预测价值相对较好,1997、2012 Partin表对精囊侵犯及淋巴结转移预测较准确.2012版对预测淋巴结转移优于其他3个版本.4种版本均对包膜侵犯预测较差.联合1997版和2012版Partin表可以提高预测准确性.     

Combining prostrate-specific antigen and Gleason score increases the diagnostic power of endorectal coil magnetic resonance imaging in prostate cancer pathological stage

BackgroundThe proper use of endorectal coil MRI (eMRI) images provide detailed information for the real extent of locally prostate cancer invasion and involvement of pelvic lymph nodes. This study evaluated the accuracy of endorectal coil magnetic resonance imaging (eMRI) results, combining the preoperative prostate-specific antigen (PSA), and the biopsy Gleason score to improve the diagnostic accuracy of prostate cancer (PCa) with organ-confined disease (OCD) or extracapsular extension (ECE)/seminal vesicle invasion (SVI).MethodsBetween 2001 and 2007, 94 PCa patients received eMRI testing during presurgical evaluation and underwent radical prostatectomy. As a part of routine patient workup, serum PSA level and Gleason score after pathology examination were recorded. The eMRI images were used to help assess patient PCa staging status regarding OCD or ECE/SVI. These stage assessments as evaluated through the use of MRI were compared with the final specimen pathological stage after the patients underwent radical prostatectomy.ResultsOf the total 94 patients in our study, 65 had stage pT2, 12 had stage pT3a, and 17 had stage pT3b PCa. In patients with clinical stage T2 PCa, the Gleason score significantly improved the discriminative ability of eMRI to successfully predict PCa at the OCD stage. Otherwise, in cases of clinical stage T3 PCa, accurate determination of PSA levels significantly improved eMRI predictive ability to assess ECE or SVI staging.ConclusionIn clinical stage T2 PCa patients, integrating the biopsy Gleason score improved the discriminative ability to assess OCD PCa staging. Additionally, combining the preoperative PSA levels of clinical T3 prostate cancer cases with Gleason scores significantly improved the sensitivity and accuracy of eMRI diagnosis to distinguish ECE from SVI.     

Biological determinants of cancer progression in men with prostate cancer

CONTEXT: The recent increase in ability to diagnose prostatic adenocarcinoma has created a dilemma for treatment decisions. OBJECTIVE: To determine whether prostate cancer progression is associated with a modified version of the Gleason grading system together with selected morphologic and clinical variables. DESIGN: Retrospective analysis of a cohort of patients with peripheral zone prostate cancers who underwent surgery between August 1983 and July 1992. SETTING: University hospital. PATIENTS: Radical prostatectomy specimens from 379 men treated only by surgical excision were prospectively studied for 8 morphologic variables using previously standardized techniques. Variables were percentage of each cancer occupied by Gleason grade 4/5 (% Gleason grade 4/5, the Stanford modified Gleason scale), cancer volume, vascular invasion, lymph node involvement, seminal vesicle invasion, capsular penetration, positive surgical margin, prostate weight, and preoperative prostate-specific antigen (PSA) level. MAIN OUTCOME MEASURE: Biochemical progression of prostate cancer as indicated by serum PSA level of 0.07 ng/mL and increasing. RESULTS: Cancer grade expressed as % Gleason grade 4/5 and cancer volume were highly predictive of disease progression. In a Cox proportional hazards model that included % Gleason grade 4/5, the traditional Gleason score was not an independent predictor of treatment failure. Positive lymph node findings and intraprostatic vascular invasion were the only other variables that remained significant at the .01 level. CONCLUSION: The % Gleason grade 4/5, cancer volume, positive lymph node findings, and intraprostatic vascular invasion were independently associated with prostate cancer progression, defined by an increasing PSA level. Techniques to accurately measure cancer volume and % Gleason grade 4/5 are needed to better predict which patient will experience cancer progression. The commonly accepted predictors of progression-capsular penetration and positive surgical margins-were not independently predictive of failure after radical prostatectomy.     

前列腺癌根治术后病理升级的临床危险因素分析

目的：探讨前列腺癌根治术后病理升级的临床危险因素。方法： 回顾性分析2011年7月至2014年10月160例经前列腺穿刺活检确诊为前列腺腺癌行根治性手术患者的临床资料。患者年龄57~82岁（平均71.6岁）,前列腺特异性抗原（prostate specific antigen,PSA）0.31~40.32 μg/L（平均11.29 μg/L）,体重指数（body mass index,BMI）16.41~32.04 kg/m2（平均23.63 kg/m2）。前列腺体积（prostate volume,PV）9.52~148.46 mL（平均40.19 mL）,其中PV<30 mL者60例（37.5%）、30~50 mL者48例（30.0%）、≥50 mL者52例（32.5%）。临床分期≤T2a、T2b和≥T2c者分别为91例（56.9%）、49例（30.6%）和20例（12.5%）,穿刺Gleason评分为6、7和≥8者分别为69例（43.1%）、67例（41.9%）和24例（15.0%）。收集患者确诊时年龄、BMI、PSA、PV、穿刺针数、穿刺阳性百分数、临床分期、穿刺Gleason评分等,比较术前穿刺病理Gleason评分与术后大体病理Gleason评分,使用单因素和多因素Logistic回归分析评估引起前列腺癌根治术后病理升级的危险因素。结果： 大体病理与术前穿刺病理Gleason评分一致者82例（51.3%）,较术前穿刺病理升级者49例（30.6%）,较术前穿刺病理降级者29例（18.1%）。术后病理升级的单因素分析中,患者年龄、BMI、穿刺前PSA、临床分期、穿刺针数均无统计学意义（P>0.05）,前列腺体积（P=0.035）和穿刺病理Gleason评分（P=0.043）具有统计学意义,进入多因素分析。多因素Logistic回归分析显示,穿刺Gleason评分低（P=0.035）和前列腺体积小（P=0.013）是前列腺癌根治术后大体病理升级的独立危险因素。结论： 前列腺癌根治术后病理Gleason评分较术前穿刺病理存在升级现象,前列腺体积小和穿刺Gleason评分低是其独立危险因素。     

Should patients with a pre-operative prostatespecific antigen greater than 15ng/ml be offered radical prostatectomy?

Background Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) τ;15ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery. Aim To assess the outcome of patients who underwent RRP with a pre-operative PSA ≥ 15ng/ml. Methods Thirty-four patients, mean pre-operative PSA: 25.46ng/ml (15.03–76.6) and mean Gleason score: 6.4 (5–9) were assessed. Results Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30–106). Mean PSA: 18.8ng/ml (15.03–25.84). Mean Gleason score: 6.1 (5–7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36–98). Mean PSA: 28.9ng/ml (15.28–76.6). Mean Gleason score: 6.7 (5–9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2). Conclusion RRP seems feasible in patients whose pre-operative PSA is between 15 and 25ng/ml with stage T1c, Gleason score ≤ 7 and negative lymph node frozen section.     

Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease.

CONTEXT AND OBJECTIVE: Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy. DESIGN AND SETTING: Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de S?o Paulo. METHODS: We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens. RESULTS: Sixteen of the 32 patients (50%) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56%) had tumors with involvement of the prostate capsule and ten (31%) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7%) had focal invasion of the prostate capsule and five (31.25%) had organ-confined disease. CONCLUSION: Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.     

磁共振扫描对经直肠超声引导前列腺穿刺活检的影响

目的:研究前列腺穿刺前行磁共振（MRI）扫描对结果的影响,并分析其对于前列腺癌（PCa）诊断的帮助。方法:回顾性选取行经直肠超声引导前列腺穿刺的住院患者,按照穿刺前是否行MRI扫描分为两组,调查其病理结果、穿刺针数、前列腺特异性抗原（PSA）、前列腺体积（PV）等,对确诊PCa患者,统计其阳性针数占比、Gleason评分、局部侵犯神经和骨转移情况。使用统计学方法分析MRI扫描对穿刺的影响。结果:共372例患者纳入统计,其中行MRI患者255例,未行MRI患者117例。MRI组患者穿刺阳性率（52.2%vs41.0%, P=0.046）、高危患者比例（78.9%vs64.6%, P=0.049）、阳性针数占比（69.9%vs54.2%, P=0.048）均高于Non-MRI组。年龄（P=0.116）、PSA（P=0.078）、f/tPSA（P=0.329）、PV（P=0.291）、PSAD（P=0.302）之间均无组间差异,在穿刺针数（P=0.001）、阳性针数占比（P=0.039）中存在统计学差异。结论:前列腺穿刺作为PCa术前确诊最重要的技术手段,有必要在前列腺穿刺前为所有可疑患者行MRI检查,在此基础上增加穿刺针数,以获得更高的穿刺效率。     

SRD5A2基因A49T多态性与前列腺癌风险性关系的研究

目的探讨SRD5A2基因多态性A49T(49密码子苏氨酸替代丙氨酸)与前列腺癌预后的关系。方法用Mwo1限制性内切酶对A49T多态性位点进行酶切鉴定,观察112例前列腺癌组织和89例前列腺增生组织的A49T的AA、AT、TT基因型多态性分布情况的差异及该多态性与前列腺癌患者的年龄、前列腺特异性抗原(PSA)、F/T、Gleason评分、分期的关系。结果前列腺癌与前列腺增生组的A49T基因频度风险无显著性差异(P>0.05)。前列腺癌组年龄明显高于增生组(P<0.05),AT+TT型患者发病年龄明显低于AA型(P<0.05),AT+TT基因型可能预后较差。AT+TT基因型患者Gleason评分平均水平明显高于AA基因型(P<0.05)。用分段评价PSA、Gleason评分、T分期、年龄,结果均与两种基因型无相关性,提示基因型与预后无显著性差异。AA、AT+TT基因型与Gleason评分的关系,等级评分(2～10分)与分段评价法(≤6、>6分)结果不一致。结论用等级评分与分段评价法结果不一致。等级评分法比分段法或许更能反映Gleason评分与A49T基因型的关系,更适用于估计预后。