Chin Arnold I, Dave Dhiren S, Rajfer Jacob
Department of Urology, University of California School of Medicine Los Angeles, CA.
Rev Urol. 2007 Summer;9(3):124-31.
Numerous studies have cited the positive predictive value of isolated highgrade prostatic intraepithelial neoplasia (HGPIN) to the detection of cancer. Epidemiological, morphological, and molecular data support the potential for malignant transformation of HGPIN, yet no current method can discriminate which lesions will progress to clinically significant prostate cancer versus more latent lesions. Recent analyses of multiple retrospective studies have found similar rates of cancer detection following either diagnosis of isolated HGPIN or an initial negative biopsy. This may reflect increased use of extended biopsy techniques involving 10 or more cores rather than the true ability of HGPIN to undergo malignant transformation. This article discusses controversies surrounding management of an isolated diagnosis of HGPIN and whether repeat biopsy of HGPIN should be mandatory or selective in the context of other predictive values such as rising prostate-specific antigen or lesion on digital rectal examination.
许多研究都引用了孤立性高级别前列腺上皮内瘤变（HGPIN）对癌症检测的阳性预测价值。流行病学、形态学和分子数据支持HGPIN发生恶性转化的可能性，但目前尚无方法能够区分哪些病变会进展为具有临床意义的前列腺癌，哪些病变更为隐匿。最近对多项回顾性研究的分析发现，在诊断孤立性HGPIN或初次活检阴性后，癌症检测率相似。这可能反映了涉及10个或更多穿刺针芯的扩展活检技术使用增加，而非HGPIN真正发生恶性转化的能力。本文讨论了围绕孤立性HGPIN诊断管理的争议，以及在前列腺特异性抗原升高或直肠指检发现病变等其他预测价值的背景下，对HGPIN进行重复活检应是强制性的还是选择性的。
