Roscigno Marco, Scattoni Vincenzo, Freschi Massimo, Raber Marco, Angiolilli Diego, Galosi Andrea, Lacetera Vito, Montironi Rodolfo, Muzzonigro Giovanni, Deho Federico, Feroldi Luca, Deiana Gianfranco, Chinaglia Daniela, Montorsi Francesco, Da Pozzo Luigi Filippo
Dept. of Urology and Pathology, Ospedali Riuniti di Bergamo, Italy.
Arch Ital Urol Androl. 2010 Dec;82(4):242-7.
To evaluate factors that may predict prostate cancer (PCa) detection after initial diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) on 6-24 cores prostatic biopsies (PBx).
We retrospectively evaluated 193 patients submitted from 1998 to 2007 to prostate re-biopsy after initial HGPIN diagnosis in three urologic departments. HGPIN diagnosis was obtained on initial systematic PBx with 6 to 24 random cores. All patients were re-biopsied with a "saturation" PBx with 18-26 cores with a median time to re-biopsy of 12 months. All slides were reviewed by expert uro-pathologists.
Plurifocal HGPIN (pHGPIN) was found in 103 patients and monofocal HGPIN (mHGPIN) in 90. Seventy-two and 121 patients were submitted to > 12-core initial biopsy and < or = 12-core, respectively. Overall PCa detection at re-biopsy was 28.4%. PSA (6.7 vs 8.5 ng/ml; p = 0.029) and age (64 vs 68 years; p = 0.005) were significantly higher in patients with PCa at re-biopsy. PCa detection was significantly higher in patients who underwent a < or = 12-core initial PBx than in those with > 12-core (35.5% vs 16.8%; p = 0.03), and in patients with pHGPIN than in those with mHGPIN (34.9% vs 21%; p = 0.035). At multivariable analysis, PSA value (p = 0.007; HR:1.18), prostate volume (p = 0.01; HR:0.966), age (p < 0.001; HR:1.15), pHGPIN (p = 0.003; HR:2.97) and < or = 12-core initial biopsy (p = 0.012; HR:3.62) were independent predictors of PC detection. We further analysed the 2 groups of patients submitted to < or = 12-core and > 12-core initial PBx. Plurifocal HGPIN and older age at biopsy were independent predictors in patients with < or = 12-core initial PBx. On the contrary, in patients with > 12-core initial biopsy, higher PSA values and lower prostate volume were independent predictors of PC detection.
PCa detection on saturation re-biopsy after initial diagnosis of HGPIN is significantly higher in patients submitted to < or = 12-core than those submitted to > 12-core initial PBx. In patients with < or = 12-core initial biopsy pHGPIN and older age were predictors of PCa detection at re-biopsy. In patients with > 12-core initial biopsy, higher PSA values and lower prostate volume was associated to an increased risk of PCa detection at re-biopsy.
评估在6 - 24针前列腺穿刺活检（PBx）初次诊断为高级别前列腺上皮内瘤变（HGPIN）后可能预测前列腺癌（PCa）检出的因素。
我们回顾性评估了1998年至2007年间在三个泌尿外科科室初次诊断为HGPIN后接受前列腺再次活检的193例患者。HGPIN诊断是通过对6至24个随机穿刺针芯的初次系统性PBx获得的。所有患者均接受了18 - 26针的“饱和”PBx再次活检，再次活检的中位时间为12个月。所有切片均由专业泌尿病理学家进行复查。
103例患者发现多灶性HGPIN（pHGPIN），90例为单灶性HGPIN（mHGPIN）。分别有72例和121例患者接受了>12针的初次活检和≤12针的初次活检。再次活检时总体PCa检出率为28.4%。再次活检时患有PCa的患者的前列腺特异性抗原（PSA）（6.7 vs 8.5 ng/ml；p = 0.029）和年龄（64 vs 68岁；p = 0.005）显著更高。接受≤12针初次PBx的患者的PCa检出率显著高于接受>12针初次PBx的患者（35.5% vs 16.8%；p = 0.03），且患有pHGPIN的患者的PCa检出率高于患有mHGPIN的患者（34.9% vs 21%；p = 0.035）。在多变量分析中，PSA值（p = 0.007；风险比[HR]：1.18）、前列腺体积（p = 0.01；HR：0.966）、年龄（p < 0.001；HR：1.15）、pHGPIN（p = 0.003；HR：2.97）和≤12针初次活检（p = 0.012；HR：3.62）是PC检出的独立预测因素。我们进一步分析了接受≤12针和>12针初次PBx的两组患者。多灶性HGPIN和活检时年龄较大是接受≤12针初次PBx患者的独立预测因素。相反，在接受>12针初次活检的患者中，较高的PSA值和较小的前列腺体积是PC检出的独立预测因素。
初次诊断为HGPIN后进行饱和再次活检时，接受≤12针初次PBx的患者的PCa检出率显著高于接受>12针初次PBx的患者。在接受≤12针初次活检的患者中，pHGPIN和年龄较大是再次活检时PCa检出的预测因素。在接受>12针初次活检的患者中，较高的PSA值和较小的前列腺体积与再次活检时PCa检出风险增加相关。
