Precise staging of prostatic cancer after radical prostatectomy
- 作者: Pushkar DY.1, Bormotin AV1
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- 期: 编号 3 (2003)
- 页面: 11-14
- 栏目: Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/274876
- ID: 274876
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Aim. To analyse data of the preoperative examination of patients and histomorphological examination of prostatectomy samples to determine parameters allowing staging prostatic cancer (PC).
Material and methods. 27 patients with staged clinically diagnosed PC have undergone radical prostatectomy with histomorphological examination of the intraoperative samples of the prostate.
Results. The preoperative evaluation of PC has revealed no cases with Glisson's scale (GS) score under 5. Only 8.7% of the tumors were well differentiated, of them 28.3% had the score 7 and higher. 85% of the cases were moderately dfifferentiated adenocarcinomas with the score 5 to 7. 33.3% patients had cancer diagnosed by prostatic biopsy (Tic). Nearly 48% had the tumor T2b, T2c. Histomorphologically, 50.7% of tumors were advanced. A high PSA level, a high score by Glisson and a clinical stage of the tumor at least T2b indicated high probability of extracapsular spread and of metastases to the lymph nodes each. The Glisson's score was higher at analysis of prostatectomy samples than prostatic biopsy in 10 (37%) cases while it was lower only in 2 (7.4%) cases. In 5 (18.5%) patients the difference made up 2 and more scores by Glisson.
Conclusion. Thin needle biopsy examinations underestimate PC stage. To stage and predict the disease course precisely it is necessary to make a multifactor analysis.
Material and methods. 27 patients with staged clinically diagnosed PC have undergone radical prostatectomy with histomorphological examination of the intraoperative samples of the prostate.
Results. The preoperative evaluation of PC has revealed no cases with Glisson's scale (GS) score under 5. Only 8.7% of the tumors were well differentiated, of them 28.3% had the score 7 and higher. 85% of the cases were moderately dfifferentiated adenocarcinomas with the score 5 to 7. 33.3% patients had cancer diagnosed by prostatic biopsy (Tic). Nearly 48% had the tumor T2b, T2c. Histomorphologically, 50.7% of tumors were advanced. A high PSA level, a high score by Glisson and a clinical stage of the tumor at least T2b indicated high probability of extracapsular spread and of metastases to the lymph nodes each. The Glisson's score was higher at analysis of prostatectomy samples than prostatic biopsy in 10 (37%) cases while it was lower only in 2 (7.4%) cases. In 5 (18.5%) patients the difference made up 2 and more scores by Glisson.
Conclusion. Thin needle biopsy examinations underestimate PC stage. To stage and predict the disease course precisely it is necessary to make a multifactor analysis.
参考
- Parker S. L., Tong Т., Bolden S., Wingo P. A. Cancer statistics. СА Cancer J. Clin. 1997; 47: 5-27.
- Greenlee R. T. et al. Cancer statistics 2000. Ibid. 2001; 51: 15- 36.
- Iversen P., Adolfsson J., Johansson J.-E. Localised prostate cancer: A Scandinavian view. Monogr. Urol. 1994; 15: 93-112.
- Fair W. R., Cookson M. S., Stoumbakis N. The indications, rationale and results of neoadjuvant androgen deprivation in the treatment of prostatic cancer. Urology 1997; 49 (suppl. ЗА): 46-55.
- Watson R. В., Soloway M. S. Neoadjuvant hormonal treatment before radical prostatectomy. Semin. Urol. Oncol. 1996; 14: 48-56.
- Грачева Л. С. Выявление и предоперационный прогноз клинически незначимого рака предстательной железы. Рус. мед. журн. 1997; 5 (4): 77-180.
- Epstein J. I., Pizov G., Walsh P. С. Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer 1993; 71: 3582-3593.
- Ohori M., Wheeler T. M., Kattan M. W. et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens. J. Urol. (Baltimore) 1995; 154: 1818-1824.
- Walsh P. C., Partin A. W., Epstein J. I. Cancer control and quality of life following anatomical radical prostatectomy: Results at 10 years. Ibid. 1994; 152: 1831-1836.
- Лоран О. Б., Пушкарь Д. Ю., Кан Я. Д. и др. Радикальная простатэктомия у больных раком предстательной железы без признаков экстракапсулярной инвазии. В кн.: Актуальные вопросы лечения онкоурологических заболеваний: Материалы 2-й Всероссийской конф. с участием стран СНГ. Обнинск; 1997. 156.
- Partin A. W., Kattan M. W., Subong M. S. et al. Combination of prostatespecific antigen, clinical stage and Gleason score to predict pathological stage of localized prostate cancer: a multiinstitutional update. J. A. M. A. 1999; 277: 1445-1451.
- Partin A. W., Mangold L. A., Lamm D. M. et al. Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology 2001; 58: 843-848.
- Noldus J., Stamey T. A. Histological characteristics of radical prostatectomy specimens in men with a serum prostate specific antigen of 4 ng/ml or less. J. Urol. (Baltimore) 1996; 155: 441 - 443.
- Weldon V. E., Tavel F. R., Neuwirth H. et al. Failure of focal prostate cancer on biopsy to predict focal prostate cancer: The importance of prevalence. Ibid. 1995; 154: 1074-1077.
- Miller G. J., Cygan J. M. Morphology prostate cancer: The effects of multifocality on histological grade, tumor volume and capsule penetration. Ibid. 1994; 152: 1709-1713.
- Ravery V., Szabo J., Toublan M. et al. A single positive prostate biopsy in six does not predict a low-volume prostate tumor. Br. J. Urol. 1996; 77: 724-728.
- Partin A. W., Yoo J. K., Carter H. B. et al. The use of prostatespecific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J. Urol. (Baltimore) 1993; 150: 110-113.
- Epstein J. I., Walsh P. C., Brendler С. В. Radical prostatectomy for impalpable prostate cancer: The Johns Hopkins experience with tumors found on transurethral resection (stage Tla and Tib) and on needle biopsy (stage Tic). Ibid. 1994; 152: 1721 - 1729.
- Ohori M., Wheeler T. M., Kay Dunn J. et al. The pathological features and prognosis of prostate cancer detectable with current diagnosis tests. Ibid. 1994; 152: 1714-1720.
- Huland H., Hammerer P., Henke R. P. et al. Preoperative prediction of tumor heterogeneity and recurrence after radical prostatectomy for localized prostatic carcinoma with digital rectal examination, prostate-specific antigen and the results of 6 systematic biopsy. Ibid. 1996; 155: 1344-1347.
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