Department of Urology and Pathology, Ospedali Riuniti di Bergamo, Bergamo, Italy.
BJU Int. 2012 May;109(9):1329-34. doi: 10.1111/j.1464-410X.2011.10532.x. Epub 2011 Sep 2.
Study Type--Diagnostic (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Multifocality, age, PSA values, and biopsy protocols regarding the predictive value of high grade PIN have been discussed extensively in the literature. Our study developed for the first time a predictive nomogram that could be helpful for patient counselling and to guide the urologist to perform rPBX after an initial diagnosis of isolated HGPIN.
• To evaluate factors that may predict prostate cancer (PCa) detection after the initial diagnosis of high-grade prostatic intra-epithelial neoplasia (HGPIN) on prostate biopsy (PBx) with six to 24 random cores.
• We retrospectively evaluated 262 patients submitted from 1998 to 2007 to prostate re-biopsy (rPBx) after an initial HGPIN diagnosis in tertiary academic centres. • HGPIN diagnosis was obtained on initial systematic PBx with six to 24 random cores. • All patients were re-biopsied with a 'saturation' rPBx with 20-26 cores, with a median time to rPBx of 12 months. • All slides were reviewed by expert uropathologists.
• Plurifocal HGPIN (pHGPIN) was found in 115 patients and monofocal HGPIN (mHGPIN) was found in 147 patients. • In total, 108 and 154 patients, respectively, were submitted to >12-core initial PBx and ≤12-core initial PBx. • Overall PCa detection at rPBx was 31.7%. PSA level (7.7 vs 6.6 ng/mL; P= 0.031) and age (68 vs 64 years; P= 0.001) were significantly higher in patients with PCa at rPBx. • PCa detection was significantly higher in patients with a ≤12-core initial PBx than in those with a >12-core initial PBx (37.6% vs 23.1%; P= 0.01), as well as in patients with pHGPIN than in those with mHGPIN (40% vs 25.1%; P= 0.013). • At multivariable analysis, PSA level (P= 0.041; hazards ratio, HR, 1.08), age (P < 0.001; HR, 1.09), pHGPIN (P= 0.031; HR, 1.97) and ≤12-core initial PBx (P= 0.012; HR, 1.95) were independent predictors of PCa detection. • A nomogram including these four variables achieved 72% accuracy for predicting PCa detection after an initial HGPIN diagnosis.
• PCa detection on saturation rPBx after an initial diagnosis of HGPIN is significantly higher in patients with a ≤12-core initial PBx than those with a >12-core initial PBx and in patients with pHGPIN than in those with mHGPIN. • We developed a simple prognostic tool for the prediction of PCa detection in patients with initial HGPIN diagnosis who were undergoing saturation rPBx.
本研究类型为诊断性病例系列研究。证据等级 4。目前已知的情况是什么？本研究有何新发现？多灶性、年龄、PSA 值和活检方案等因素已在高分级前列腺上皮内瘤变（HG PIN）的预测价值方面进行了广泛讨论。我们首次开发了一个预测列线图，该列线图有助于患者咨询，并指导泌尿科医生在初始诊断为孤立性 HG PIN 后进行重复经直肠前列腺穿刺活检（r PBx）。
评估在初次经直肠前列腺穿刺活检（PBx）诊断为高级别前列腺上皮内瘤变（HG PIN）后，有多少患者在 6 至 24 个随机核心的情况下可检测到前列腺癌（PCa）。
我们回顾性评估了 1998 年至 2007 年间在三个学术中心因初次 HG PIN 诊断而接受重复前列腺活检（r PBx）的 262 例患者。HG PIN 的诊断是在初次采用 6 至 24 个随机核心的系统 PBx 中获得的。所有患者均接受“饱和”r PBx 检查，采用 20-26 个核心，r PBx 的中位时间为 12 个月。所有切片均由经验丰富的泌尿病理学家进行评估。
115 例患者存在多灶性 HG PIN（pHG PIN），147 例患者存在单灶性 HG PIN（mHGPIN）。分别有 108 例和 154 例患者接受了>12 核初始 PBx 和≤12 核初始 PBx。r PBx 时总的 PCa 检出率为 31.7%。r PBx 时 PCa 检出率与 PSA 水平（7.7 vs 6.6ng/mL；P=0.031）和年龄（68 vs 64 岁；P=0.001）显著相关。≤12 核初始 PBx 的患者与>12 核初始 PBx 的患者（37.6% vs 23.1%；P=0.01）、pHG PIN 患者与 mHGPIN 患者（40% vs 25.1%；P=0.013）相比，r PBx 时 PCa 检出率更高。多变量分析显示，PSA 水平（P=0.041；风险比 HR 1.08）、年龄（P<0.001；HR 1.09）、pHG PIN（P=0.031；HR 1.97）和≤12 核初始 PBx（P=0.012；HR 1.95）是 r PBx 时 PCa 检出的独立预测因素。包含这四个变量的列线图对初始 HG PIN 诊断后 r PBx 时 PCa 检出的预测准确率为 72%。
在初次诊断为 HG PIN 后进行饱和 r PBx 时，与>12 核初始 PBx 相比，≤12 核初始 PBx 和 pHG PIN 患者的 PCa 检出率明显更高。我们开发了一种简单的预测工具，用于预测初次诊断为 HG PIN 且行饱和 r PBx 的患者中 PCa 的检出情况。
