Department of Urology, University of Brescia, Spedali Civili Hospital, Brescia, Italy.
Prostate Cancer Prostatic Dis. 2011 Jun;14(2):173-6. doi: 10.1038/pcan.2011.3. Epub 2011 Mar 1.
The aim of this study was to analyse the factors that predict the diagnosis of prostate cancer (PCa) after high-grade prostatic intraepithelial neoplasia (HGPIN). Data from 546 patients with HGPIN submitted up to a 6-month series of three rebiopsies, according to an institutional protocol, were reviewed. PCa has been found in 174 cases (31.8%), in 116 cases at the first and in 58 cases at a further rebiopsy. The risk of finding PCa at the first rebiopsy was correlated with the PSA value and with an anomalous digital rectal examination (DRE) at the time of the initial biopsy; the risk at a subsequent rebiopsy was correlated to the number of cores with HGPIN, with a cutoff of four, and to the ratio with the total number of cores ('PIN density'), with a cutoff of 50%, at the time of initial biopsy. A tailored protocol of controls can be suggested: (a) higher PSA value and/or anomalous DRE: early extended or saturation rebiopsy; (b) number of cores with HGPIN ≥4 and/or PIN density ≥50%: delayed rebiopsy; and (c) no risk factors: PSA and DRE controls.
本研究旨在分析预测高级别前列腺上皮内瘤变（HGPIN）后前列腺癌（PCa）诊断的因素。根据机构方案，对 546 例 HGPIN 患者的资料进行了回顾性分析，这些患者接受了长达 6 个月的 3 次重复活检。在 174 例（31.8%）患者中发现了 PCa，116 例在第一次活检时发现，58 例在进一步的重复活检时发现。首次重复活检时发现 PCa 的风险与 PSA 值和初始活检时异常的直肠指检（DRE）相关；随后重复活检时的风险与初始活检时 HGPIN 的核心数量（以 4 个为界）和与总核心数的比值（“PIN 密度”，以 50%为界）相关。可以建议制定个性化的控制方案：（a）较高的 PSA 值和/或异常的 DRE：早期进行扩展或饱和重复活检；（b）HGPIN 核心数≥4 和/或 PIN 密度≥50%：延迟重复活检；（c）无风险因素：PSA 和 DRE 监测。
