Minardi Daniele, Galosi Andrea B, Dell'Atti Lucio, Hanitzsch Herbert, Mario Polito, Muzzonigro Giovanni
Institute of Urology, University of Ancona Medical School, Ancona, Italy.
Scand J Urol Nephrol. 2002;36(5):323-9. doi: 10.1080/003655902320783818.
High serum total prostate-specific antigen (PSA) levels have proven to be predictive of concurrent cancer but the role of prostatic intraepithelial neoplasia (PIN) in the production of total (t) and free (f) PSA is still the subject of research. In this study we wanted to discover whether variations in serum fPSA and tPSA levels are caused by PIN.
We reviewed the medical records of 87 patients: in 32 of them the diagnosis of isolated PIN was made from surgical samples (simple prostatectomy, n = 19; radical cystectomy, n = 13); in 30 patients a diagnosis of benign prostatic hyperplasia (BPH) without PIN or prostatic carcinoma was made after simple prostatectomy (n = 20) or radical cystectomy (n = 10); and in 25 patients a clinically significant prostatic cancer was diagnosed and these patients underwent radical prostatectomy. All patients underwent a standard preoperative evaluation, including serum fPSA and tPSA determinations and PSA density.
The frequency of isolated PIN in simple prostatectomy specimens was 6.3%. The mean f/t PSA ratios were 17.66% in the 32 patients with PIN, 19.2% in the 8 patients with low-grade PIN, 17.6% in the 24 patients with high-grade PIN, 24.2% in patients with BPH and 13% in patients who underwent radical prostatectomy.
We believe that to make a definitive diagnosis of isolated PIN without carcinoma, study of the whole prostate gland is necessary, in order to definitively exclude the presence of concurrent neoplastic foci. Our data show that PIN does not contribute to tPSA levels and density; however, it may be responsible for a slight reduction in the f/t PSA ratio, with a significant reduction in cases with high-grade PIN (17.6%) compared to those with BPH (24.2%).
高血清总前列腺特异性抗原（PSA）水平已被证明可预测同时存在的癌症，但前列腺上皮内瘤变（PIN）在总PSA（tPSA）和游离PSA（fPSA）产生中的作用仍是研究课题。在本研究中，我们想探究血清fPSA和tPSA水平的变化是否由PIN引起。
我们回顾了87例患者的病历：其中32例经手术样本确诊为孤立性PIN（单纯前列腺切除术，n = 19；根治性膀胱切除术，n = 13）；30例患者在单纯前列腺切除术（n = 20）或根治性膀胱切除术（n = 10）后被诊断为无PIN或前列腺癌的良性前列腺增生（BPH）；25例患者被诊断为具有临床意义的前列腺癌，这些患者接受了根治性前列腺切除术。所有患者均接受了标准的术前评估，包括血清fPSA和tPSA测定以及PSA密度测定。
单纯前列腺切除标本中孤立性PIN的发生率为6.3%。32例PIN患者的平均f/t PSA比值为17.66%，8例低级别PIN患者为19.2%，24例高级别PIN患者为17.6%，BPH患者为24.2%，接受根治性前列腺切除术的患者为13%。
我们认为，要对无癌的孤立性PIN做出明确诊断，有必要对整个前列腺进行研究，以明确排除同时存在的肿瘤病灶。我们的数据表明，PIN对tPSA水平和密度没有影响；然而，它可能导致f/t PSA比值略有降低，与BPH患者（24.2%）相比，高级别PIN患者（17.6%）的f/t PSA比值显著降低。
