Prostate volume predicts high grade prostate cancer both in digital rectal examination negative (ct1c) and positive (≥ct2) patients

Introduction We aimed to assess the relationship between prostate volume (PV) and high grade prostate carcinoma (HGPCa) in patients with benign and suspicious digital rectal examination (DRE) in our prostate biopsy cohort. Materials and methods Between 2009-2012, 759 consecutive initial transrectal systematic 12 cores prostate biopsies were included. PVs were calculated with transrectal ultrasound. Only prostate adenocarcinomas (PCa) were included into the study. For standardization, patients with missing data, and who have been exposed to any form of hormonal or radiation therapy were excluded. Patients were categorized with DRE (negative or positive) and Gleason sum [<7: low grade PCa(LGPCa), ≥7: HGPCa]. Results Median PV was significantly lower in patients with HGPCa. There was a significantly increased risk of HGPCa with PV according to all groups in univariate logistic regression (LR). The significant relationship continued in multivariate LR with PSA and age. We found a PV cut-off value of 47.9cc for HGPCa. HGPCa was significantly higher in <47.9 volume, both in DRE positive and negative patients and in the whole cohort, although LGPCa did not differ significantly. Conclusions There is a significant relationship between HGPCa and decreasing PV. The continued significant relationship both in DRE negative and positive patients reinforces this relation.

引言 本研究旨在评估本中心前列腺活检队列中，直肠指检（digital rectal examination，DRE）结果为良性或可疑的患者的前列腺体积（prostate volume，PV）与高级别前列腺癌（high grade prostate carcinoma，HGPCa）之间的关联。
材料与方法 2009年至2012年间，本研究纳入759例连续接受首次经直肠系统性12针前列腺活检的患者。前列腺体积通过经直肠超声计算得出。本研究仅纳入前列腺腺癌（prostate adenocarcinoma，PCa）患者。为保证研究标准化，排除存在数据缺失、曾接受任何形式激素或放射治疗的患者。根据直肠指检结果（阴性或阳性）以及格里森评分（Gleason sum）对患者进行分组：评分＜7分为低级别前列腺癌（low grade prostate carcinoma，LGPCa），≥7分为高级别前列腺癌（HGPCa）。
结果 高级别前列腺癌患者的前列腺体积中位数显著更低。单因素logistic回归（logistic regression，LR）分析显示，所有亚组中高级别前列腺癌的发病风险均随前列腺体积降低而显著升高。在校正前列腺特异性抗原（prostate-specific antigen，PSA）水平与年龄后，多因素logistic回归分析仍显示该关联具有统计学意义。本研究确定高级别前列腺癌对应的前列腺体积截断值为47.9cc。无论直肠指检结果为阳性还是阴性，以及在全队列中，前列腺体积＜47.9cc的患者中高级别前列腺癌的检出率均显著更高；而低级别前列腺癌的检出率在各组间无显著差异。
结论 高级别前列腺癌与前列腺体积降低之间存在显著关联。无论直肠指检结果为阴性还是阳性，该关联均持续存在，进一步验证了这一结论。