低估前列腺切片格里森分級與達文西機械手臂輔助前列腺根除手術探討
洪梵菁1，連繼志1，洪健華1，呂育全1，蔣智宏1,2，張宏江1，蒲永孝1，黃昭淵1
國立台灣大學附設醫院 泌尿部1, 台北榮民總醫院員山分院 泌尿部2
Biopsy Grade Group 1: underestimation and Outcomes after RaLRP
Fan-Ching Hung1, Chi-Chih Lien1, Jian‑Hua Hong1, Yu-Chuan Lu1, Chih-Hung Chiang1,2,
Hong-Chiang Chang1, Yeong-Shiau Pu1, Chao-Yuan Huang1
Department of Urology, National Taiwan University Hospital1, Department of Urology, Taipei Veterans General Hospital Yuanshan Branch2
Purpose: We intended to analyze the outcomes and predictive factors for underestimating the prostate cancer (PCa) grade group 1 (GG1) from prostate biopsies in patients treated by robot-assisted laparoscopic radical prostatectomy (RaLRP).
Materials and Methods: 165 patients with initial prostate biopsy grade group 1 (Gleason score ≦3+3) prostate cancer and underwent RaLRP between 2012 and 2018 were included in this study. We explored clinical and pathological features and outcomes associated with a GG upgrade from biopsy to RP. Logistic regression was used to predict upgrading for GG1.
Results: Biopsy GG1 was upgraded after RP in 76.7% of cases. In univariate analysis, variables predicting upgrading for GG1 PCa were abnormal digital rectal examination, smaller prostate volume and higher PSA density. In multivariate analysis, prostate volume <30 mL (odds ratio 3.24, 95% CI [1.372-7.658]) and PSA density≧0.2 (odds ratio 2.56, 95% CI [1.012-6.452]) were significant predictors. Patients who upgraded from GG1 to GG3 had a shorter time to biochemical recurrence than those who remained GG1 (P=0.001) during 5 years of follow-up.
Conclusions: Biopsy GG1 can be misleading, as underestimation was noted in 76.7% of our cases. PSA density, smaller prostate, abnormal DRE could be helpful in prediction of upgrading. Upgrade of GG1 can influence clinical outcomes after RaLRP.