Gokden Neriman, Roehl Kimberly A, Catalona William J, Humphrey Peter A
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Urology. 2005 Mar;65(3):538-42. doi: 10.1016/j.urology.2004.10.010.
To assess the current incidence of prostate carcinoma detection in serial biopsies in a prostate-specific antigen-based screening population after a diagnosis of isolated high-grade prostatic intraepithelial neoplasia (HG-PIN) in needle biopsy tissue.
We retrospectively identified 190 men with a diagnosis of isolated HG-PIN in needle biopsy tissue. Most men (86%) were diagnosed from 1996 to 2000. Logistic regression analysis was used to predict the presence of carcinoma in these 190 men and in a control group of 1677 men with only benign prostatic tissue in needle biopsy tissue.
The cumulative risk of detection of carcinoma on serial sextant follow-up biopsies was 30.5% for those with isolated HG-PIN compared with 26.2% for the control group (P = 0.2). Patient age (P = 0.03) and serum prostate-specific antigen level (P = 0.02) were significantly linked to the risk of cancer detection, but suspicious digital rectal examination findings (P = 0.1), the presence of HG-PIN (P = 0.2), and the histologic attributes of PIN were not (all with nonsignificant P values). HG-PIN found on the first repeat biopsy was associated with a 41% risk of subsequent detection of carcinoma compared with an 18% risk if benign prostatic tissue was found on the first repeat biopsy (P = 0.01).
The results of our study have shown that the current level of risk for the detection of prostate carcinoma in a screened population is 30.5% after a diagnosis of isolated HG-PIN in a needle biopsy. This risk level is lower than the previously reported risk of 33% to 50%. HG-PIN is a risk factor for carcinoma detection only when found on consecutive sextant biopsies. The data presented here should prompt reconsideration of repeat biopsy strategies for HG-PIN, and re-evaluation of the absolute necessity of repeat biopsy for all patients with HG-PIN.
评估在针吸活检组织诊断为孤立性高级别前列腺上皮内瘤变（HG-PIN）后，基于前列腺特异性抗原的筛查人群中系列活检时前列腺癌的当前检出率。
我们回顾性地确定了190例针吸活检组织诊断为孤立性HG-PIN的男性。大多数男性（86%）于1996年至2000年被诊断。采用逻辑回归分析预测这190名男性以及1677名针吸活检组织仅为良性前列腺组织的对照组男性中癌的存在情况。
对于孤立性HG-PIN患者，系列六分区随访活检时癌的累积检出风险为30.5%，而对照组为26.2%（P = 0.2）。患者年龄（P = 0.03）和血清前列腺特异性抗原水平（P = 0.02）与癌的检出风险显著相关，但直肠指检可疑结果（P = 0.1）、HG-PIN的存在（P = 0.2）以及PIN的组织学特征则不然（所有P值均无统计学意义）。首次重复活检发现HG-PIN时，后续癌的检出风险为41%，而首次重复活检发现良性前列腺组织时为18%（P = 0.01）。
我们的研究结果表明，在针吸活检诊断为孤立性HG-PIN后，筛查人群中前列腺癌的当前检出风险水平为30.5%。该风险水平低于先前报道的33%至50%的风险。仅当在连续的六分区活检中发现HG-PIN时，它才是癌检出的危险因素。此处呈现的数据应促使重新考虑HG-PIN的重复活检策略，并重新评估所有HG-PIN患者重复活检的绝对必要性。
