Focus Pathology, South Yarra, Victoria, Australia.
BJU Int. 2012 Apr;109 Suppl 3:22-6. doi: 10.1111/j.1464-410X.2012.11040.x.
What's known on the subject? and What does the study add? In the era of extended biopsy sampling of the prostate, multifocal high-grade prostatic intraepithelial neoplasia (HGPIN) is associated with a significantly higher rate of cancer diagnosis than unifocal HGPIN or a benign diagnosis. In addition, the cancers that are subsequently diagnosed in men with HGPIN on their initial biopsy tend to be smaller, lower grade and more commonly organ-confined. This has led to a reappraisal of the need and timing of repeat biopsies. The present paper provides a series of recommendations on the optimal timing of repeat biopsies in men with HGPIN on biopsy, based on the current available evidence. This is the first of a two part series reviewing the nature and clinical significance of in situ cellular proliferations in the prostate gland. This first part examines prostatic intraepithelial neoplasia (PIN), while the second part in the next supplement discusses intraductal carcinoma and ductal adenocarcinoma of the prostate. PIN is a precursor lesion in the development of some forms of adenocarcinoma of the prostate. In the 1990 s, high-grade PIN (HGPIN) on biopsy was a significant predictor of carcinoma, but this was due to incomplete sampling with sextant biopsies. With more extensive sampling in the last decade, the likelihood of identifying cancer after a diagnosis of HGPIN is not significantly different from a benign diagnosis. In several recent studies, it is now recognised that multifocal HGPIN is a better predictor of cancer than unifocal HGPIN. Most cases of cancer will be detected in the vicinity of the HGPIN, but up to 40% of cancers will occur in different sextants. In assessing potential markers for carcinoma in men with HGPIN on biopsy, α-methylacyl coenzyme-A racemase (AMACR) has emerged as a promising diagnostic tool. HGPIN with strong staining for AMACR is associated with a higher rate of cancer detection in subsequent biopsies compared with AMACR-negative HGPIN. Also, AMACR positivity in HGPIN is more commonly seen adjacent to carcinoma, and this may provide guidance as to the site of future biopsies.
已知的主题是什么？本研究有何新发现？在广泛进行前列腺活检采样的时代，多灶性高级别前列腺上皮内瘤变（HGPIN）与癌症诊断率显著高于单灶性 HGPIN 或良性诊断。此外，在初次活检中发现 HGPIN 的男性中，随后诊断出的癌症往往更小、分级更低，且更常见于器官内局限。这导致人们重新评估重复活检的必要性和时间。本文基于现有证据，就 HGPIN 男性重复活检的最佳时间提供了一系列建议。这是两部分系列文章的第一部分，该系列文章回顾了前列腺腺体中原位细胞增殖的性质和临床意义。这第一部分检查了前列腺上皮内瘤变（PIN），第二部分在下一期增刊中讨论了前列腺导管内癌和导管腺癌。PIN 是某些形式的前列腺腺癌发展的前体病变。在 20 世纪 90 年代，活检中的高级别 PIN（HGPIN）是癌症的重要预测指标，但这是由于 sextant 活检的不完全采样所致。在过去十年中，随着更广泛的采样，在诊断为 HGPIN 后发现癌症的可能性与良性诊断并无显著差异。在最近的几项研究中，现在已经认识到多灶性 HGPIN 比单灶性 HGPIN 更能预测癌症。大多数癌症将在 HGPIN 附近被发现，但多达 40%的癌症将出现在不同的 sextant 中。在评估 HGPIN 男性中潜在的癌症标志物时，α-甲基酰基辅酶 A 消旋酶（AMACR）已成为一种很有前途的诊断工具。与 AMACR 阴性 HGPIN 相比，AMACR 染色强的 HGPIN 与后续活检中更高的癌症检出率相关。此外，HGPIN 中的 AMACR 阳性更常见于癌旁，这可能为未来的活检部位提供指导。
