Fowler J E, Bigler S A, Miles D, Yalkut D A
Department of Pathology, University of Mississippi School of Medicine and Section of Urology, Veterans Affairs Medical Center, Jackson, USA.
J Urol. 2000 Mar;163(3):813-8.
We determine demographic and tumor related predictors of repeat biopsy cancer detection in men with suspected stage T1c-2 prostate cancer.
The study population included 298 consecutive men with suspected stage T1c-2 prostate cancer who had a benign prostate biopsy at 1 institution between January 1, 1992 and April 1, 1999 and underwent 1 repeat biopsy. Mean age plus or minus standard deviation was 66.8+/-6.7 years for 133 black (55%) and 165 white (45%) patients. Clinical measures included determination of high grade prostatic intraepithelial neoplasia in benign biopsy specimens, Gleason score of malignant biopsy specimens, prostate specific antigen (PSA), PSA density, annualized interbiopsy PSA change, percent free PSA (201 cases) and PSA velocity (171).
Cancer was detected on repeat biopsy in 80 cases (27%). Significant differences between patients with benign and malignant repeat biopsies included age (p = 0.001), PSA density (p = 0.0001), percent free PSA (p = 0.0001) and PSA velocity (p = 0.009). High grade prostatic intraepithelial neoplasia in an initial benign biopsy was not predictive of cancer in repeat biopsy (p = 0.12). Multiple logistic regression analysis of all cases showed that age (p = 0.002) and PSA density (p = 0.0002) were independent predictors of cancer. Subset multiple logistic regression analysis modeled with age, PSA density and percent free PSA demonstrated that age (p = 0.002) and percent free PSA (p = 0.0001) were significant independent predictors of malignancy. Subset multiple logistic regression analysis modeled with age, PSA density, percent free PSA and PSA velocity revealed that age (p = 0.02) and percent free PSA (p = 0.0003) were significant independent predictors of cancer. There were no significant differences between the Gleason scores of cancers detected on repeat biopsy compared to 587 stage T1c-2 cancers detected on initial biopsy during the study period (p = 0.09). PSA, PSA density, percent free PSA and PSA velocity were not significantly different among men without a cancer diagnosis who had high grade neoplasia in 1 or 2 benign biopsies.
Greater than 25% of this population of select patients with suspected stage T1c-2 prostate cancer had malignancy detected on repeat biopsy. Percent free PSA was the most powerful predictor of cancer. High grade prostatic intraepithelial neoplasia was not a predictor of repeat biopsy cancer detection and PSA functions were similar among men without cancer who did and did not have high grade neoplasia in 1 or more benign biopsies. This finding suggests that high grade prostatic intraepithelial neoplasia may not be a reliable indicator of clinically significant existing prostate cancer.
我们确定疑似T1c - 2期前列腺癌男性患者重复活检癌症检测的人口统计学和肿瘤相关预测因素。
研究人群包括1992年1月1日至1999年4月1日期间在1家机构接受良性前列腺活检并进行1次重复活检的298例连续的疑似T1c - 2期前列腺癌男性患者。133例黑人（55%）和165例白人（45%）患者的平均年龄±标准差为66.8±6.7岁。临床指标包括良性活检标本中高级别前列腺上皮内瘤变的测定、恶性活检标本的Gleason评分、前列腺特异性抗原（PSA）、PSA密度、活检间期PSA年化变化、游离PSA百分比（201例）和PSA速率（171例）。
80例（27%）患者重复活检发现癌症。良性和恶性重复活检患者之间的显著差异包括年龄（p = 0.001）、PSA密度（p = 0.0001）、游离PSA百分比（p = 0.0001）和PSA速率（p = 0.009）。初次良性活检中的高级别前列腺上皮内瘤变不能预测重复活检中的癌症（p = 0.12）。对所有病例进行的多因素逻辑回归分析表明，年龄（p = 0.002）和PSA密度（p = 0.0002）是癌症的独立预测因素。以年龄、PSA密度和游离PSA百分比为模型的亚组多因素逻辑回归分析表明，年龄（p = 0.002）和游离PSA百分比（p = 0.0001）是恶性肿瘤的显著独立预测因素。以年龄、PSA密度、游离PSA百分比和PSA速率为模型的亚组多因素逻辑回归分析显示，年龄（p = 0.02）和游离PSA百分比（p = 0.0003）是癌症的显著独立预测因素。与研究期间初次活检发现的587例T1c - 2期癌症相比，重复活检发现的癌症的Gleason评分无显著差异（p = 0.09）。在1次或2次良性活检中有高级别瘤变但未诊断出癌症的男性中，PSA、PSA密度、游离PSA百分比和PSA速率无显著差异。
在这群选定的疑似T1c - 2期前列腺癌患者中，超过25%的患者在重复活检时检测到恶性肿瘤。游离PSA百分比是癌症最有力的预测因素。高级别前列腺上皮内瘤变不是重复活检癌症检测的预测因素，在1次或多次良性活检中有或没有高级别瘤变的无癌男性中，PSA功能相似。这一发现表明，高级别前列腺上皮内瘤变可能不是临床显著的现有前列腺癌的可靠指标。
