Brausi Maurizio, Castagnetti Giovanni, Dotti Alberto, De Luca Giuseppe, Olmi Riccardo, Cesinaro Anna Maria
Department of Urology, Ospedale Sant'Agostino-Estense, University of Modena and Reggio Emilia, Via Sant'Agostino 18, 41100 Modena, Italy.
J Urol. 2004 Sep;172(3):906-8; discussion 908-9. doi: 10.1097/01.ju.0000134622.54235.93.
The term atypical small acinar proliferation (ASAP) has been proposed by pathologists to indicate foci of small atypical acini found in prostatic biopsies that have some but not all of the features of adenocarcinoma. We determined the incidence of ASAP at our institution and evaluated the role of immediate radical prostatectomy (RP) in these patients.
From January 2001 to December 2002, 1,327 patients underwent systematic transrectal prostate biopsies because of increased prostate specific antigen (PSA). Of the 1,327 patients 71 (5.3%) had suspicious cytokeratin negative lesions diagnosed as ASAP, as confirmed by a review pathologist. Mean patient age was 62 years and mean PSA was 8.48 ng/ml (range 5.6 to 19.6). Of the 71 patients 25 underwent pelvic bilateral lymphadenectomy and RP with a nerve sparing procedure immediately after the diagnosis of ASAP. A 79-year-old patient underwent transurethral resection of the prostate. A total of 45 patients were followed with PSA determination every 3 months and with prostatic mapping every 6 months (12 to 14 biopsies).
All 25 patients (100%) with ASAP who underwent immediate RP had a final pathological diagnosis of adenocarcinoma, as confirmed by a review pathologist. Pathological stage was pT2a in 9 patients, pT2b in 8, pT2c in 6, pT3a in 1 and pT4 in 1. The Gleason sum was 2 to 6 in 21 patients, 7 in 2 and 8 in 2. One of the 25 patients had positive nodes (pT4N1G3). The pathological diagnosis in patients with transurethral resection was benign prostatic hyperplasia. Nine of the 45 patients who were followed were seen every 3 months for PSA determination because of age (older than 78 years). Of the 45 patients 23 (51.1%) underwent a second set of biopsies, which revealed adenocarcinoma in 6 of 23 (26%), benign prostatic hyperplasia in 6 (26%), ASAP again in 5 (21.7%), atypia in 4 (17.3%) and high grade PIN in 2 (8.6%). Six of 17 patients had a third set of biopsies (a total of 14 cores), including 3 with adenocarcinoma, 1 with ASAP and 2 with high grade PIN. Two of 45 patients (4.4%) did not undergo a second biopsy because of other malignancies. Four of 45 patients (8.8%) are awaiting a third or fourth biopsy. Ten of 45 patients (22.2%) were lost to followup.
The results of our study confirm that immediate RP could be the treatment of choice in young patients with ASAP.
病理学家提出了非典型小腺泡增生（ASAP）这一术语，用于指示在前列腺活检中发现的具有部分但并非全部腺癌特征的小非典型腺泡灶。我们确定了我院ASAP的发生率，并评估了即刻根治性前列腺切除术（RP）在这些患者中的作用。
2001年1月至2002年12月，1327例因前列腺特异性抗原（PSA）升高接受了系统性经直肠前列腺活检。在这1327例患者中，71例（5.3%）经复审病理学家确诊为可疑细胞角蛋白阴性病变，诊断为ASAP。患者平均年龄为62岁，平均PSA为8.48 ng/ml（范围5.6至19.6）。在这71例患者中，25例在诊断为ASAP后立即接受了盆腔双侧淋巴结清扫和保留神经的RP手术。1例79岁患者接受了经尿道前列腺切除术。45例患者每3个月进行一次PSA测定，每6个月进行一次前列腺定位检查（12至14次活检）。
所有25例接受即刻RP的ASAP患者最终病理诊断为腺癌，经复审病理学家确认。病理分期为pT2a的有9例，pT2b的有8例，pT2c的有6例，pT3a的有1例，pT4的有1例。21例患者的Gleason评分总和为2至6分，2例为7分，2例为8分。25例患者中有1例淋巴结阳性（pT4N1G3）。经尿道前列腺切除术患者的病理诊断为良性前列腺增生。45例接受随访的患者中有9例因年龄（大于78岁）每3个月进行一次PSA测定。在这45例患者中，23例（51.1%）接受了第二次活检，其中23例中有6例（26%）发现腺癌，6例（26%）为良性前列腺增生，5例（21.7%）再次为ASAP，4例（17.3%）为非典型增生，2例（8.6%）为高级别PIN。17例患者中有6例进行了第三次活检（共14个芯），其中3例为腺癌，1例为ASAP，2例为高级别PIN。45例患者中有2例（4.4%）因其他恶性肿瘤未接受第二次活检。45例患者中有4例（8.8%）正在等待第三次或第四次活检。45例患者中有10例（22.2%）失访。
我们的研究结果证实，即刻RP可能是年轻ASAP患者的首选治疗方法。
