Discontinuous tumor involvement (DTI) is a not uncommon finding in the tumor in prostate needle core biopsies undertaken for diagnosis of prostate cancer (PCa). The objective of this review is to establish a clear definition of DTI in order to provide a standardized method of measurement which reliably reflects pathologic features and disease progression following radical prostatectomy (RP). A systematic literature search was performed using PubMed up to March 2020 to identify studies of PCa patients which included needle biopsies containing DTI and matched subsequent RP treatment with or without follow-up information. The methodology and quality of reporting of DTI are reviewed, compared, and summarized. DTI is a frequent finding in diagnostic biopsy for PCa (up to 30%). Six studies were compared by methods of measurement used for predicting pathologic features and outcomes which are observed in subsequent RP. In most cases with DTI (> 90%), intervening benign tissue in the tumor core was less than 5 mm. DTI found in the biopsy was likely to be associated with a single, irregular tumor nodule going in and out of the plane of the section, but DTI was not associated with multiple small foci of the tumor. Immunohistochemistry (IHC) also demonstrated that about 75% of cases of DTI shared an IHC profile which supports the concept that DTI most likely comes from a homogeneous tumor nodule. Furthermore, DTI was associated with positive surgical margin (PSM) and bilateral tumor in RP specimens. Compared to additive measurement (with the subtraction of intervening benign tissue), linear measurement (including intervening benign tissue) of DTI was more accurately predictive of aggressive disease in the RP including higher pT stage, PSM, and greater actual extent of the tumor. However, the advantage of linear measurement was lost in cases where there was an upgrade from the biopsy to the RP which may result from undersampling. For cases with either very small tumor foci or very extensive cancer volume, no difference was observed in these two methods of measurement. DTI in core biopsies may represent undersampling of a larger irregular nodule but likely does not result from multifocality and is similarly unlikely to represent multiclonality. Linear measurement of DTI was more accurately predictive of post-RP pathologic findings and oncologic prognosis. This method should be applied for patient selection for AS.

在诊断前列腺癌（PCa）的前列腺穿刺针活检中，不连续肿瘤累及（DTI）并非罕见。这篇综述的目的是建立DTI的明确定义，以便提供一种标准化的测量方法，该方法能够可靠地反映根治性前列腺切除术（RP）后的病理特征和疾病进展。截至2020年3月，使用PubMed进行了系统的文献检索，以鉴定PCa患者的研究，其中包括含DTI的穿刺活检并匹配后续的RP治疗（有或没有随访信息）。审查，比较和总结了DTI报告的方法和质量。DTI是PCa诊断活检的常见发现（高达30％）。通过测量方法对六项研究进行了比较，这些方法用于预测随后的RP中观察到的病理特征和结果。在大多数情况下，DTI（> 90％）时，肿瘤核心中的良性组织小于5 mm。活检中发现的DTI可能与单个不规则肿瘤结节进入和离开切片平面有关，但DTI与肿瘤的多个小灶无关。免疫组织化学（IHC）也证明了大约75％的DTI病例具有IHC谱，这支持了DTI最有可能来自均质肿瘤结节的概念。此外，DTI与RP标本的阳性手术切缘（PSM）和双侧肿瘤相关。与相加测量（减去介入的良性组织）相比，线性测量DTI（包括介入的良性组织）可更准确地预测RP中的侵袭性疾病，包括更高的pT分期，PSM和更大的实际肿瘤范围。但是，如果由于取样不足而导致活组织检查升级为RP，则会失去线性测量的优势。对于肿瘤灶很小或癌症体积非常大的病例，在这两种测量方法中均未观察到差异。核心活检中的DTI可能代表较大不规则结节的欠采样，但可能不是多焦点导致的，同样不太可能代表多克隆。线性测量DTI可以更准确地预测RP后的病理结果和肿瘤的预后。该方法应适用于AS患者的选择。