Potts J M
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Urol. 2000 Nov;164(5):1550-3.
Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance.
From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinary tract infection and PSA greater than 30 ng./ml., without a rectum or who refused biopsy were excluded from study.
Of the 187 study patients 122 were evaluable with a mean PSA of 9.35 ng./ml., including 51 (42%) with laboratory signs of prostatitis. After treatment PSA was normal in 22 cases and remained elevated in 29, including 9 in which biopsy revealed cancer. The change or improvement in PSA was significantly greater in men with benign results than in those with prostate cancer (-21.32 versus -1.33%, p = 0.001). In the cohort with negative expressed prostatic secretion and VB3 results transrectal ultrasound guided biopsy was done promptly. Screening decreased the number of biopsies by 18% (22 of 122 cases). The positive predictive value of PSA for detecting biopsy proved cancer improved with screening for prostatitis (45 of 122 cases or 37% versus 36 of 71 or 51%). Long-term followup revealed continued normal or stable PSA in the prostatitis cohort.
Screening for NIH category IV prostatitis should be considered in men with elevated PSA. Although patients may be asymptomatic, anxiety caused by prostate cancer and diagnostic procedures contributes to the clinical significance of this disorder.
尽管前列腺炎可能导致前列腺特异性抗原（PSA）升高，但在进行经直肠活检以排除癌症之前，通常不会对无症状患者进行该诊断的常规筛查。许多阴性活检显示出被归类为美国国立卫生研究院（NIH）IV类前列腺炎或无症状炎症的前列腺炎证据。据我们所知，本报告是对活检前男性中NIH IV类前列腺炎发病率及其临床意义的初步研究。
1996年至1998年，对PSA水平升高的无症状男性进行前列腺炎实验室指标评估。前列腺分泌物或前列腺按摩后尿液（排尿瓶3 [VB3]）中每高倍视野白细胞分别大于20个和大于10个的患者接受4周抗生素治疗，并在6至8周后重新评估。没有这些临床体征的男性立即接受活检。患有急性尿路感染且PSA大于30 ng/ml、没有直肠或拒绝活检的患者被排除在研究之外。
187名研究患者中，122名可评估，平均PSA为9.35 ng/ml，其中51名（42%）有前列腺炎实验室指标。治疗后，22例PSA正常，29例仍升高，其中9例活检发现癌症。PSA的变化或改善在良性结果的男性中明显大于前列腺癌患者（-21.32%对-1.33%，p = 0.001）。在前列腺分泌物和VB3结果为阴性的队列中，立即进行经直肠超声引导活检。筛查使活检数量减少了18%（122例中的22例）。筛查前列腺炎后，PSA检测活检证实为癌症的阳性预测值有所提高（122例中的45例或37%对71例中的36例或51%）。长期随访显示前列腺炎队列中PSA持续正常或稳定。
PSA升高的男性应考虑筛查NIH IV类前列腺炎。尽管患者可能无症状，但前列腺癌和诊断程序引起的焦虑导致了这种疾病的临床意义。
