試分析經直腸超音波導引下十針系統性隨機切片和攝護腺癌腫瘤分佈
之相關性-是否能由經直腸超音波攝護腺切片結果預測病理分期？
吳冠諭、蔡育賢、楊文宏、蔡宗欣
成功大學醫學院附設醫院泌尿部
Analysis of prostate cancer foci in patients with transrectal 10-core systemic random biopsy—can we predict pathological stage of prostate cancer through trus biopsy?
Kuan-Yu Wu, Yuh-Shyan Tsai, Wen-Horng Yang, Tzong-Shin Tzai
Department of Urology, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
Purpose:
The aim of this study is evaluating the detection site of prostate cancer foci in patients receiving transrectal ultrasound(TRUS) guided 10-core systemic random biopsy and comparing the relationship between digital rectal examination and prostatic biopsy. The study ultimately aims to predict pathological staging of prostate cancer by TRUS-biopsy.
Materials and Methods:
Between September 2005 and June 2014, 1314 men received TRUS-guided biopsy were included in this study. Indications for TRUS guided prostate biopsy were: abnormal digital rectal examination and/or a serum PSA over 4.0 ng/ml. 701 patients were excluded due to less than 10 cores or received target biopsy and 68 patients were excluded due to different machine. Finally, 545 patients underwent at least 10-core random biopsy protocol by TRUS and 46 of those patients treated with radical retropubic prostatectomy.
Results:
Of the 545 patients, one hundred and fifty-two (27.9%) were positive for prostate cancer, including 64 of 370 (16.2 %) men with normal DRE and 88 of 175 (50.3 %) with abnormal DRE. Patients with normal DRE exhibited younger age (67.9 vs. 71.0 yrs, p=0.007), lower serum PSA(15.7 vs. 25.6 ng/ml, p=0.0032), lower PSA density(0.41 vs. 0.71, p=0.0016), less positive cores(p=0.022), and less Gleason score(p= 0.0006) than those with abnormal DRE.
46 of those patients treated with radical retropubic prostatectomy, including 17 men with normal DRE and 29 with abnormal DRE. The pathological finding revealed higher number of positive biopsy cores in advanced staging whether digital finding was positive or not. For evaluating the association of the detection site of prostate cancer foci and pathological staging, we defined low, intermittent, and high risk group according to number of positive cores in different locations (lateral, parasagittal, and apical area). We identified low risk group with no positive core. Intermittent risk group means one positive core or 2 positive cores ipsilateral (2S). High risk group means 2 positive cores contralateral (2C) or number of positive cores more than 3. Otherwise, we also reclassified pathological staging into 3 subgroups: pT2a and pT2b, pT2c, and pT3a at least. The pathological finding of patient with low risk group will below pT2c and high-risk group will above pT3. (p =0.031 in lateral sites, p=0.007 in parasagittal sites, and p=0.023 in apical sites).
Conclusions:
In our study, patient with normal digital rectal examination and PSA elevation received TURS-biopsy has 16% malignancy change. Besides, patients with abnormal digital rectal examination received TURS-biopsy has 50% malignancy change. Patients with normal DRE exhibited younger age, lower serum PSA, lower PSA density, less positive cores, and less Gleason score than those with abnormal DRE. The cancer foci detected by biopsies of the prostate are equally distributed even subgroup analysis depending on location of positive cores or prostate size. Prediction of pathological stage in prostate cancer through TRUS 10-core random biopsy is available in this study.