前列腺穿刺活检单针阳性患者前列腺内癌灶分布特点

Distribution characteristics of cancerous foci in the prostate among patients undergoing single positive core biopsy

目的:通过对前列腺穿刺活检单针阳性并接受根治性手术治疗的前列腺癌患者的手术标本病理结果进行回顾分析,了解前列腺内癌灶的分布情况。方法:对我院37例经直肠前列腺穿刺活检,单针阳性确诊为前列腺癌并接受前列腺癌根治术的患者手术前后资料进行比较,评价活检与术后病理结果的非一致性,分析肿瘤总体被低估的可能危险因素。结果:多数患者(26/37)术后病理证实肿瘤呈多灶性分布;术后Gleason评分7～9分患者(21/37)所占比例明显升高;术前临床分期明显被低估;单针中癌组织比例大是术前临床分期被低估的可能危险因素;PSAD>0.2μg/L是肿瘤总体被低估的可能危险因素;前列腺体积较大(体积≥40 ml)时肿瘤多灶性分布的可能性增大。结论:前列腺穿刺活检单针阳性患者的肿瘤可能被低估;其前列腺癌灶的分布具有多灶性特点。

Objective： To determine the distribution characteristics of cancerous foci in the prostate by retrospective analysis on the radical prostatectomy（RP） samples from patients with prostate cancer diagnosed by single positive core biopsy and treated by RP.Methods： Thirty-seven patients with prostate cancer diagnosed by ultrasound-guided biopsy and single positive core biopsy underwent RP.We reviewed the pre-and post-operative data of the patients,compared the results of biopsies and pathological examination of the RP samples,and analyzed the factors that led to the underestimation of the overall prostate cancer risks.Results： Post-operative pathological results showed multifocal distribution of the tumors in 70% of the patients（26/37）,and obviously increased Gleason score（7-9） in 56%（21/37）.The clinical stages of the tumors had been significantly underestimated preoperatively.The underestimation of their clinical stages might be due to a larger proportion of cancer tissues in a single positive core biopsy,and that of the overall cancer risks attributed to PSAD0.2 μg/L.Larger prostate volume（≥40 ml） increased the possibility of multifocal distribution.Conclusion： The risk of prostate cancer diagnosed by single positive core biopsy might be underestimated,and the cancerous foci were characterized by multifocal distribution in the prostate.