文章：

诊断为有利中危前列腺癌患者的病情升级——主动监测是否真的适合所有患者？

Upstaging of Patients Diagnosed with Favorable Intermediate-Risk Prostate Cancer—Is Active Surveillance Really a Suitable Approach for All These Patients?

原文发布日期：27 October 2025

DOI: 10.3390/cancers17213444

类型: Article

开放获取: 是

英文摘要：

Background & Objectives: Current guidelines recognize a subgroup of favorable intermediate-risk (FIR) ISUP grade group (GG) 2 prostate cancer (PCa) that may be eligible for active surveillance (AS). However, upgrading and upstaging to more aggressive disease are frequently observed. We aimed to identify risk factors for adverse pathology in this cohort to better define clinical scenarios where AS may need to be reconsidered. Methods: We retrospectively analyzed 170 patients diagnosed with ISUP GG2 PCa by multiparametric MRI (mpMRI)/TRUS fusion biopsy, all treated with radical prostatectomy (RP). Patients with FIR disease were evaluated for upstaging to ≥pT3 or upgrading to ISUP GG of ≥3 at RP. Multivariable logistic regression identified predictors of adverse pathology. Key Findings and Limitations: Among 170 FIR patients, median PSA was 5.6 ng/mL. Most had PI-RADS 4 (57%) or 5 (20%) lesions; 13% were diagnosed by systematic biopsy only. At RP, 28% showed adverse pathology, including 5 patients (2.9%) with lymph node metastases. Independent predictors were a PI-RADS Score of ≥4, PSA of >7 ng/mL, and clinical T-stage on digital rectal examination. Conclusions and Clinical Implications: Nearly 1/3 of FIR PCa patients were upstaged to high-risk PCa at RP. Based on these findings, AS in clinical practice should only be considered after thorough patient counseling and performed using a stringent follow-up and staging regimen to minimize the risk of further disease progression. A key limitation is the lack of the percentage of Gleason pattern 4.

摘要翻译： 

背景与目的：当前指南认为，存在一部分预后良好的中危组（FIR）ISUP分级组（GG）2级前列腺癌（PCa）患者可能适合接受主动监测（AS）。然而，临床上常观察到疾病升级和分期上升至更具侵袭性的情况。本研究旨在识别该队列中不良病理的风险因素，以更明确地界定可能需要重新考虑AS的临床情况。方法：我们回顾性分析了170例通过多参数磁共振成像（mpMRI）/经直肠超声（TRUS）融合活检诊断为ISUP GG2 PCa的患者，所有患者均接受了根治性前列腺切除术（RP）治疗。对FIR患者在RP中升级至≥pT3分期或升级至ISUP GG≥3的情况进行评估。通过多变量逻辑回归分析确定不良病理的预测因素。主要发现与局限性：在170例FIR患者中，中位PSA为5.6 ng/mL。大多数患者具有PI-RADS 4级（57%）或5级（20%）病灶；13%仅通过系统活检确诊。在RP中，28%的患者显示不良病理，包括5例（2.9%）淋巴结转移。独立预测因素包括PI-RADS评分≥4、PSA>7 ng/mL以及数字直肠检查的临床T分期。结论与临床意义：近1/3的FIR PCa患者在RP中升级为高危PCa。基于这些发现，临床实践中考虑AS时，应在充分患者咨询后进行，并采用严格的随访和分期方案，以最小化疾病进一步进展的风险。一个关键局限性是缺乏Gleason模式4的百分比数据。

原文链接：

Upstaging of Patients Diagnosed with Favorable Intermediate-Risk Prostate Cancer—Is Active Surveillance Really a Suitable Approach for All These Patients?