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。     

影响多西他赛联合泼尼松治疗转移性去势抵抗性前列腺癌疗效的因素分析

目的：探讨转移性去势抵抗性前列腺癌(metastatic castration resistant prostate cancer,mCRPC)患者接受多西他赛+泼尼松治疗有效性的影响因素。方法：回顾性分析2010年2月至2015年3月在北京大学第一医院转移性去势抵抗性前列腺癌患者接受多西他赛联合泼尼松治疗有效性的影响因素。研究纳入的多西他赛联合泼尼松治疗的mCRPC患者的临床资料,对相关的临床因素进行单因素分析。结果：共60例患者接受治疗,对其中33例临床资料完整的患者进行分析。化疗有效定义为化疗4个周期后前列腺特异性抗原（prostate specific antigen,PSA）较基线下降≥50%,且影像学改变按照实体肿瘤疗效评价标准（response evaluation criteria in solid tumors,RECIST）无进展。其化疗时中位PSA为153.4 μg/L（6.6~9 952.0 μg/L）,共20例（60.6%）为治疗有效,单因素分析后发现Gleason评分较低者化疗有效性较差（P=0.034）;化疗时存在淋巴结转移者有效率较高（P=0.032）;内脏转移者共15例,其中12例（80%）患者治疗有效（P=0.041）;化疗时出现贫血的患者（HGB≤120 g/L）共10例,化疗有效者3例（30%,P=0.024）。结论：对于mCRPC患者,初发时Gleason评分≤7、诊断时合并淋巴结转移、内脏转移以及化疗时存在贫血是化疗能否有效的预测因素。     

80岁及以上前列腺癌患者行腹腔镜前列腺根治性切除术围手术期参数及预后

目的：分析北京大学第三医院泌尿外科收治的超高龄（≥80岁）前列腺癌患者的围手术期参数、术后控尿功能恢复及肿瘤学预后,探讨中国人群超高龄前列腺癌患者接受腹腔镜前列腺根治性切除术治疗的安全性和有效性。方法：选择2007年1月至2016年12月于北京大学第三医院因前列腺腺癌行腹腔镜前列腺根治性切除术的超高龄（≥80岁）患者进行回顾性分析,纳入标准为患者年龄≥80岁,经组织病理学检查确诊为前列腺腺癌,临床资料齐备。所有患者均经腹膜外途径行腹腔镜前列腺根治性切除术,收集患者临床资料、围手术期参数、术后病理资料等。术后3个月、6个月和1年对患者控尿功能恢复情况进行随访,定期检测血清前列腺特异性抗原（prostate specific antigen, PSA）水平,将生化复发定义为连续两次血清PSA水平大于0.2 μg/L者,应用Kaplan-Meier生存曲线分析患者无生化复发生存率和总生存率,多因素COX回归分析影响超高龄前列腺癌患者术后生化复发的危险因素。结果：所有51例患者年龄（81.6±1.6）岁,穿刺前PSA (15.19±13.68) μg/L,穿刺Gleason评分为6分、7分和≥8分者分别为14例（27.5%）、19例（37.3%）和18例（35.3%）,临床分期为T1、T2和T3期者分别为6例（11.8%）、31例（60.8%）和14例（27.5%）,ASA分级Ⅰ级者6例,Ⅱ级者45例。所有患者均完成手术,手术时间（189.6±69.1） min,手术出血量（169.9±163.5） mL,11例（21.6%）患者发生围手术期并发症。通过超高龄前列腺癌患者腹腔镜前列腺根治性切除术(laparoscopic radical prostatectomy,LRP)术后的大体标本病理进行分析,术后病理分期T2期者29例（56.9%）,T3期22例者（43.1%）,其中包膜侵犯者18例（35.3%）,精囊侵犯者4例（7.8%）;大体病理Gleason评分6分、7分和≥8分者分别为8例（15.7%）、21例（41.1%）和22例（43.1%）,术后病理切缘阳性者14例（27.5%）。截止2017年10月术后随访10~118个月,中位随访时间42个月,术后3个月、6个月和1年超高龄前列腺癌患者行LRP术后的尿控率分别为64.7%(33/51)、82.4%(42/51)和 92.2%(47/51)。在随访过程中,12例（23.5%）超高龄前列腺癌患者LRP术后出现生化复发,平均生化复发时间为40.9个月;4例（7.8%）患者在随访过程中死亡,其中1例（2.0%）患者因前列腺癌进展死亡,3例（5.9%）患者因其他疾病死亡。经多因素COX回归分析,影响超高龄前列腺癌患者术后生化复发的危险因素主要为高PSA水平（P=0.019）、病理分期≥T3期（P =0.017）和切缘阳性（P =0.020）。结论：对选择恰当的超高龄前列腺癌患者施行腹腔镜前列腺根治性切除术是可行的,并且远期肿瘤控制情况良好,高PSA水平、病理分期≥T3期和切缘阳性可能是超高龄前列腺癌患者术后生化复发的独立危险因素,但此结论尚需大样本量的前瞻性临床研究证实。     

根治性宫颈癌手术患者盆腔淋巴结转移和预后的影响因素分析

目的 探讨根治性宫颈癌手术患者盆腔淋巴结转移和5年生存率的影响因素。 方法 选择2007年1月-2012年12月嘉兴市妇幼保健院宫颈癌Ⅰa~Ⅱb期手术患者225例作为研究对象,收集患者的临床病理资料。 结果 225例宫颈癌患者中淋巴结转移者54例,转移率为24.0%。治疗前血红蛋白水平<110 g/L、FIGO分期Ⅱ期、肌层浸润深度 ≥ 1/2、有宫旁浸润、有淋巴血管间隙侵犯、肿瘤直径 ≥ 4 cm的淋巴结转移率高于治疗前血红蛋白水平 ≥ 110 g/L、FIGO分期Ⅰ期、肌层浸润深度<1/2、无宫旁浸润、无淋巴血管间隙侵犯、肿瘤直径<4 cm者(P<0.05)。治疗前血红蛋白水平、FIGO分期、宫旁浸润、淋巴血管间隙侵犯、肿瘤直径为宫颈癌淋巴结转移的独立影响因素(P<0.05)。宫颈癌患者的5年生存率为83.7%。年龄 ≥ 45岁、治疗前血红蛋白水平<110 g/L、FIGO分期Ⅱ期、肌层浸润深度 ≥ 1/2、有宫旁浸润、有淋巴血管间隙侵犯、肿瘤直径 ≥ 4 cm、非鳞癌、有淋巴结转移患者的5年生存率低于年龄<45岁、治疗前血红蛋白水平 ≥ 110 g/L、FIGO分期Ⅰ期、肌层浸润深度<1/2、无宫旁浸润、无淋巴血管间隙侵犯、肿瘤直径<4 cm、鳞癌、无淋巴结转移患者的5年生存率(P<0.05)。治疗前血红蛋白水平、淋巴血管间隙侵犯、非鳞癌和淋巴结转移是宫颈癌患者5年生存率的独立影响因素(P<0.05)。 结论 治疗前血红蛋白水平、FIGO分期、宫旁浸润、淋巴血管间隙侵犯、肿瘤直径为宫颈癌淋巴结转移的独立影响因素。治疗前血红蛋白水平、淋巴血管间隙侵犯、非鳞癌和淋巴结转移是宫颈癌患者预后的独立影响因素。      

多西他赛联合泼尼松治疗激素难治性前列腺癌的近期疗效观察

目的 观察多西他赛联合泼尼松化疗方案对激素难治性前列腺癌的近期疗效和不良反应。方法 采用多西他赛（75mg／m^2）联合小剂量泼尼松（5mg,2次／d）3周方案对14例51—78岁激素难治性前列腺癌患者进行3—8周期化疗,比较化疗前后总前列腺特异性抗原（T-PSA）、碱性磷酸酶、疼痛评分、骨及可测量病灶的变化等进行近期疗效评估,并了解本化疗方案的不良反应。结果 每周期总剂量在100—140mg,共治疗1—8周期不等。PSA降低反应显效5例,有效3例,无效6例,总有效率为57．1％;6例N1患者中有2例淋巴结缩小,有1例显示淋巴结有增大,余无明显变化;骨扫描化疗后2例好转;化疗后疼痛评分减轻0—6分;Kamofsky评分平均增加4％。化疗不良反应主要为骨髓抑制、脱发、乏力、甲床改变、静脉炎等。结论 多西他赛联合泼尼松化疗方案可抑制激素难治性前列腺癌的进展,使PSA降低、淋巴结缩小、减轻疼痛、改善生活质量,化疗耐受性较好。     

Artificial neural network for predicting pathological stage of clinically localized prostate cancer in a Taiwanese population

BackgroundWe developed an artificial neural network (ANN) model to predict prostate cancer pathological staging in patients prior to when they received radical prostatectomy as this is more effective than logistic regression (LR), or combined use of age, prostate-specific antigen (PSA), body mass index (BMI), digital rectal examination (DRE), trans-rectal ultrasound (TRUS), biopsy Gleason sum, and primary biopsy Gleason grade.MethodsOur study evaluated 299 patients undergoing retro-pubic radical prostatectomy or robotic-assisted laparoscopic radical prostatectomy surgical procedures with pelvic lymph node dissection. The results were intended to predict the pathological stage of prostate cancer (T2 or T3) after radical surgery. The predictive ability of ANN was compared with LR and validation of the 2007 Partin Tables was estimated by the areas under the receiving operating characteristic curve (AUCs).ResultsOf the 299 patients we evaluated, 109 (36.45%) displayed prostate cancer with extra-capsular extension (ECE), and 190 (63.55%) displayed organ-confined disease (OCD). LR analysis showed that only PSA and BMI were statistically significant predictors of prostate cancer with capsule invasion. Overall, ANN outperformed LR significantly (0.795 ± 0.023 versus 0.746 ± 0.025, p = 0.016). Validation using the current Partin Tables for the participants of our study was assessed, and the predictive capacity of AUC for OCD was 0.695.ConclusionANN was superior to LR at predicting OCD in prostate cancer. Compared with the validation of current Partin Tables for the Taiwanese population, the ANN model resulted in larger AUCs and more accurate prediction of the pathologic stage of prostate cancer.     

Presentation of prostate carcinoma with cervical lymphadenopathy: report of three cases

The most common method of spreading of prostate cancer is via direct invasion to the pelvic organs or vertebral bodies. Supraclavicular lymph node metastasis is uncommon in patients with prostate cancer. Previously researchers have shown that the prognosis after such a presentation is generally poor. We herein present three patients with prostate carcinoma presenting with supraclavicular lymph node enlargement at the initial diagnosis. Abdominal computed tomography showed multiple enlarged lymph nodes in retroperitoneal space. All of our patients had hormone therapy and the prostate specific antigen (PSA) level declined. The mean follow up time was 16 months (range, 6-24 months). None of our patients experienced progression during follow up. Prostate carcinoma should always be considered in the differential diagnosis of elderly men with cervical lymphadenopathy, even in the absence of lower urinary tract symptoms. Evaluation of the PSA level and lymph node biopsy with PSA immunohistochemistry stain can lead to the final diagnosis. In addition, hormone treatment has been shown to be of benefit even in patients in the advanced stages.     

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.     

去势抵抗性前列腺癌进展时间的预测因素分析

目的：探索前列腺癌经内分泌治疗后进入去势抵抗性前列腺癌（castration-resistant prostate cancer, CRPC）的预测因素,以更好地指导临床和提高患者预后。方法：回顾性分析了2003年1月至2014年12月在北京大学第一医院泌尿外科确诊前列腺癌并且初始治疗为内分泌治疗的患者共185例,收集并整理分析的临床信息包括患者年龄、前列腺癌TNM分期、前列腺癌病理Gleason评分（Gleason score, GS)、前列腺癌危险度、内分泌治疗开始时前列腺特异性抗原（prostate-specific antigen, PSA）水平、经过内分泌治疗后的PSA最低值、PSA下降速率以及降到PSA最低值的时间。应用Kaplan-Meier生存分析和log-rank检验比较不同分组间CRPC进展时间的差异,应用Cox风险比例回归模型来分析评估这些因素对CRPC进展时间的影响。结果：185例患者平均年龄(71.02±8.67)岁,CRPC进展的中位时间为38个月（4~158个月）。单因素分析中,前列腺癌T分期、N分期、前列腺癌危险度、内分泌治疗前是否发生远处转移、PSA下降速率和PSA最低值均与CRPC进展时间显著相关（P值均小于0.01）。在多因素分析中,内分泌治疗前已发生远处转移（HR=6.030,95% CI：3.229~11.263,P=0.001）、较高的PSA最低值（HR=1.185,95% CI：1.080~1.301,P=0.001）、PSA下降速率>11 μg/(L·month)（HR=2.124,95% CI：1.195~3.750,P=0.001）以及到达PSA最低值的时间≤9个月（HR=3.623,95% CI：1.640~4.817,P=0.004）均是CRPC进展时间较短的危险因素。结论：前列腺癌患者经过内分泌治疗后,PSA下降速率越快,进入CRPC时间越短。     

晚期前列腺癌药物去势中Gleason评分、血清PSA与疗效相关性研究

目的：探讨晚期前列腺癌（Pca）患者药物去势治疗过程中疗效与Gleason评分及血清前列腺特异性抗原（PSA）的相关性。方法：选择33例晚期Pca患者，给予黄体激素释放激素类似物（LHRH—A）＋抗雄激素药物进行药物去势治疗，根据Gleason评分分为2～5分组、6～7分组、8～10分组，对3组血清PSA变化进行分析。结呆：Gleason评分6～7分组的病人在治疗后3个月内血清PSA值下降最快，治疗后6个月时Gleason评分2～5分组病人血清PSA值恢复正常，而Gleason评分6～7分组与8～10分组病人血清PSA值则接近正常值范围。不同Gleason评分组间血清PSA水平差异有统计学意义（F=5．396，P〈O．05）。结论：（1）Gleason评分、血清PSA水平与晚期Pca患者行药物去势疗法疗效有密切关系。（2）血清PSA变化是监测Pca复发与评价疗效的可靠瘤标。     

PTEN和Eg5蛋白在前列腺癌中表达及相关性

目的 对前列腺癌中PTEN和Eg5蛋白进行免疫组化检测,探讨PTEN和Eg5蛋白表达与前列腺癌临床病理的相关性。方法 采用免疫组化SP法对2014年12月至2016年3月浙江大学医学院附属金华医院检测81例前列腺癌和45例前列腺增生PTEN和Eg5蛋白的表达,对前列腺癌临床病理资料与PTEN和Eg5表达分析,采用Spearmen对PTEN和Eg5蛋白表达进行相关性分析。结果 前列腺癌中PTEN蛋白表达阳性率为25.93%(21/81),前列腺增生中表达阳性率为88.89%(40/45),二者比较,差异有统计学意义(P0.05)。Eg5蛋白在前列腺癌中表达阳性率为70.37%(57/81),前列腺增生中表达阳性率为4.44%(2/45),二者比较,差异有统计学意义(P0.05)。PTEN蛋白缺失表达和Eg5蛋白增高表达与前列腺癌的Gleason评分、TNM分期、术前PSA、精囊浸润、盆腔淋巴结转移和五年生化复发密切相关(P0.05)。Spearmen相关性分析显示PTEN与Eg5蛋白的表达呈负相关(r=-0.763,P0.05)。结论 前列腺癌中PTEN蛋白下降表达,Eg5蛋白升高表达,它们异常表达与前列腺癌发生进展有关。     

以PSA筛查为基础前列腺癌早期诊断与治疗的研究

目的了解扬州地区60岁以上老年男性前列腺特异性抗原(PSA)水平, 探讨PSA筛查与前列腺癌早期诊断与治疗之间的联系。方法制定详细的入选与排除标准, 选取扬州地区2020年5-7月体检的60岁以上老年男性3 102例, 均具有完整随访信息。采用化学发光酶免疫分析法检测体检者血清PSA水平, 对符合前列腺癌穿刺标准者, 进行B超引导下经会阴前列腺组织穿刺活检并进行Gleason评分。结果随着年龄的增加, PSA水平异常的比例明显增高(P < 0.01)。共有62名老年人接受了前列腺穿刺活检, 其中PSA在4~10 ng/mL 38人, 穿刺诊断为癌14人(36.8%); PSA>10 ng/mL 24人, 穿刺诊断为癌15个(62.5%)。随着PSA水平的升高, 前列腺穿刺阳性的比例升高(P < 0.05)。对穿刺阳性对象的肿瘤分期发现, 随着PSA的升高, 肿瘤的Gleason评分越高, 危险系数越大(P < 0.05)。结论随年龄增加, PSA呈现上升趋势, 且PSA水平升高, 前列腺癌的发生可能性越大, 恶性程度也随之增加。对于老年男性建议进行早期、定期PSA检查。     

Monotherapeutic brachytherapy for clinically organ-confined prostate cancer

Since the mid-1980s, permanent prostate brachytherapy has been utilized increasingly as a potentially curative treatment for patients of all ages with clinically localized prostate cancer To determine the 8-year biochemical progression-free survival rate for patients who had undergone monotherapeutic brachytherapy for clinically organ-confined prostate cancer, we conducted a study of 202 patients at Schiffler Cancer Center at Wheeling Hospital in Wheeling, W.Va. These patients had undergone brachytherapy without supplemental external beam radiation therapy or androgen deprivation therapy for clinical T1b-T2c NxM0 (2002 AJCC) prostate cancer from April 1995 through May 2001. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The median follow-up was 5.2 years. All patients underwent brachytherapy more than 3 years prior to analysis. Biochemical success was defined as a PSA < 0.4 ng/mL after a nadir. Clinical, treatment and dosimetric parameters evaluated for biochemical progression-free survival included patient age, clinical T-stage, Gleason score, pretreatment PSA, risk group, percent positive biopsies, isotope, prostate volume, brachytherapy planning volume, V100/150/200, D90, tobacco status, hypertension and diabetes. For the entire group, 8-year biochemical progression-free survival was 97.4% for Pd-103 and 93.3% for I-125. The median post-treatment PSA for the entire group was < 0.1 ng/mL. In multivariate analysis, only pretreatment PSA predicted biochemical outcome with a trend for better outcome with younger patient age and lesser percent positive biopsies. The results of our study indicate that permanent interstitial brachytherapy as a monotherapeutic approach for patients with clinically organ-confined disease results in a high probability of 8-year biochemical progression-free survival with a median PSA < 0.1 ng/mL. Generous periprostatic treatment margins with documented high quality day 0 postoperative dosimetry are mandatory for such outcomes.     

不同水平前列腺特异抗原的前列腺癌诊断率

目的了解不同水平前列腺特异抗原（PSA）在前列腺系统穿刺下的活检阳性率,确定游离PSA／总PSA（fPSA／tPSA）在低PSA域值（PSA4～10ng／ml）的诊断价值。方法自2000年1月至2005年6月我们对1244例因PSA升高或直肠指检阳性结节的患者进行B超引导下经直肠前列腺穿刺活检,采用前列腺5区12针或13针系统穿刺方法,将PSA水平与组织学结果进行对比分析。结果根据PSA水平将患者分为：PSA〈4ng／ml,直肠指检发现结节;PSA4—10ng／ml,fPSA／tPSA〉0．16;PSA4—10ng／ml,fPSA／tPSA〈0．16;PSA10．1—20ng／ml;PSA〉20ng／ml;共5组,穿刺阳性率分别为18．1％,11．6％,17．4％,24．9％,和56．7％。随着PSA值增加,高危Gleason评分（Gleason评分≥18）的比例明显增加。结论不同PSA值的前列腺癌诊断率明显不同。直肠指检发现前列腺结节或PSA〉10ng／ml应作为前列腺穿刺的指征。PSA4—10ng／ml之间,参考fPSA／tPSA（〈0．16）有利于提高穿刺阳性率。     

Radiation therapy for clinically localized prostate cancer: a multi-institutional pooled analysis

CONTEXT: Prostate-specific antigen (PSA) evaluation leads to the early detection of both prostate cancer and recurrences following primary treatment. Prostate-specific antigen outcome information on patients 5 or more years following treatment is limited and available mainly as single-institution reports. OBJECTIVES: To assess the likelihood and durability of tumor control using PSA evaluation 5 or more years after radical external beam radiation therapy and to identify pretreatment prognostic factors in men with early prostate cancer treated since 1988, the PSA era. DESIGN AND SETTING: Retrospective, nonrandomized, multi-institutional pooled analysis of patients treated with external beam radiation therapy alone between 1988 and 1995 at 6 US medical centers. Follow-up lasted up to a maximum of 9 years. Outcome data were analyzed using Cox regression and recursive partitioning techniques. PATIENTS: A total of 1765 men with stage T1b, T1c, and T2 tumors treated between 1988 and 1995 with external beam radiation. The majority (58%) of patients were older than 70 years and 24.2% had initial PSA values of 20 ng/mL or higher. A minimum of 2 years of subsequent follow-up was required for participation. MAIN OUTCOME MEASURE: Actuarial estimates of freedom from biochemical failure. RESULTS: The 5-year estimates of overall survival, disease-specific survival, and the freedom from biochemical failure are 85.0% (95% confidence interval [CI], 82.5%-87.6%), 95.1% (95% CI, 94.0%-96.2%), and 65.8% (95% CI, 62.8%-68.0%), respectively. The PSA failure-free rates 5 and 7 years after treatment for patients presenting with a PSA of less than 10 ng/mL were 77.8% (95% CI, 74.5%-81.3%), and 72.9% (95% CI, 67.9%-78.2%). Recursive partitioning analysis of initial PSA level, palpation stage, and the Gleason score groupings yielded 4 separate prognostic groups: group 1, included patients with a PSA level of less than 9.2 ng/mL; group 2, PSA level of at least 9.2 but less than 19.7 ng/mL; group 3, PSA level at least 19.7 ng/mL and a Gleason score of 2 to 6; and group 4, PSA level of at least 19.7 ng/mL and a Gleason score of 7 to 10. The estimated rates of survival free of biochemical failure at 5 years are 81 % for group 1, 69% for group 2, 47% for group 3, and 29% for group 4. Of the 302 patients followed up beyond 5 years who were free of biochemical disease, 5.0% relapsed from the fifth to the eighth year. CONCLUSIONS: Estimated PSA control rates in this pooled analysis are similar to those of single institutions. These rates indicate the probability of success for subsets of patients with tumors of several prognostic category groupings. These results represent a multi-institutional benchmark for evidence-based counseling of prostate cancer patients about radiation treatment.     

前列腺癌患者血清前列腺特异抗原水平与Gleason评分相关性分析

目的 分析前列腺癌患者血清中前列腺特异性抗原(PSA)水平、游离前列腺特异抗原与总前列腺特异抗原的比值(f-PSA/t-PSA)与Gleason评分的相关性,探讨血清PSA水平在前列腺癌诊断和鉴别中的临床应用价值。 方法 回顾性分析2014年6月—2015年9月在绍兴市人民医院泌尿外科治疗的109例前列腺癌患者的临床资料,所有患者均在B超引导下经直肠前列腺活检确诊为前列腺癌,根据患者的临床资料统计有无家族遗传史,并依据癌症TNM分类标准统计患者的临床分期,统计不同分类患者血清PSA平均水平,评价患者血清PSA、f-PSA/t-PSA水平与前列腺病理组织的Gleason评分的相关性。 结果 有家族患病史患者的平均血清PSA水平为(323.59±267.15)ng/ml,远高于没有家族史的患者(198.11±100.22)ng/ml,P＜0.05;不同TNM临床分期患者的血清PSA水平差异较大,Ⅰ期患者的血清PSA水平最低,平均为(6.28±4.08)ng/ml,Ⅳ期最高,为(459.08±123.01)ng/ml;前列腺癌患者血清PSA水平与前列腺组织病理切片的Gleason评分呈正相关(r=0.367,P＜0.001)。低分化癌患者的平均血清f-PSA/t-PSA为0.145±0.017,中分化癌患者为0.225±0.021,高分化癌患者为0.345±0.104,前列腺癌病理组织的Gleason评分与血清f-PSA/t-PSA成负相关(r=-0.378,P=0.008)。 结论 血清前列腺素特异抗原与前列腺组织Gleason评分具有相关性,对前列腺癌的早期临床诊断和治疗有重要意义,应列入前列腺癌的筛查方案。      

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.     

前列腺癌根治术前新辅助治疗效果分析

目的　探讨前列腺癌根治术前新辅助治疗的疗效。方法　 31例经前列腺活检证实为局限性前列腺癌患者 ,其中 12例于前列腺癌根治术前辅以诺雷德加氟他胺 (新辅助治疗组 )平均治疗 5 .6个月 ,19例单纯行前列腺癌根治术 (单纯根治术组 ) ,比较两组的临床特征。结果　两组患者的盆腔淋巴结清扫阳性率为 12 .9%(4 / 31例 ) ,术后血清前列腺特异性抗原 (PSA)水平明显下降 (P <0 .0 1)。新辅助治疗组药物治疗后血清PSA明显降低 (P <0 .0 1) ,8例临床分期降低 ,术后前列腺切缘阳性 2例 ,精囊浸润 1例 ,淋巴结转移 1例 ;单纯根治术组前列腺切缘阳性 7例 ,精囊浸润 4例 ,淋巴结转移 3例。两组的前列腺切缘阳性率、精囊浸润率、淋巴结转移率的差异有显著性 (P值均 <0 .0 5 ) ,而手术时间、失血量和Gleason评分的差异无显著性 (P值均 >0 .0 5 )。结论　前列腺癌根治术是治疗局限性前列腺癌最有效的方法 ,术前辅以新辅助治疗可降低前列腺癌的临床分期和病理分期 ,其对远期疗效的影响有待进一步观察。