Department of Urology, University of California, San Francisco, CA 94143-1695, USA.
Prostate Cancer Prostatic Dis. 2013 Jun;16(2):165-9. doi: 10.1038/pcan.2012.51. Epub 2013 Jan 15.
Active surveillance (AS) is an appropriate management strategy for men with low-risk prostate cancer. Most protocols recommend repeated prostate biopsy every 12-24 months. The purpose of this paper is to describe histological inflammation patterns in men on AS who underwent serial prostate biopsy for disease monitoring.
We reviewed records of men on AS from January 1999 through February 2011 who had a diagnostic plus ≥1 repeat transrectal ultrasound-guided biopsies performed at our institution. The type and degree of inflammatory infiltrate were grossly reviewed and scored for each patient's biopsy by a single pathologist. Relationship of inflammation severity and number of serial biopsies was assessed using a repeated measures mixed model. Unpaired t-test and χ(2)-square analysis assessed variance in degree of inflammation and location of inflammation relative to cancer grade progression defined as Gleason sum increase.
Fifty-six men met study inclusion criteria. Mean age was 62.1 (6.5) years, 71% were stage cT1c, 79% had a PSA level <10 ng ml(-1), and 98% had diagnostic Gleason sum ≤6. A small, statistically significant increase in maximum chronic inflammation (CI) scores with greater number of repeat biopsies was observed. CI scores were not associated with number of biopsies based on upgrade status. The main limitation to our study is our small sample size. Potential unmeasured confounders, such as unreported antibiotic use or symptomatic prostatitis, may have also affected our findings.
In this pilot study of 56 men on AS for localized prostate cancer, degree of chronic histological inflammation increased with greater number of prostate biopsies, but was not associated with subsequent risk of grade progression.
主动监测（AS）是低危前列腺癌患者的一种适当的管理策略。大多数方案建议每 12-24 个月重复进行前列腺活检。本文的目的是描述接受疾病监测的 AS 男性的连续前列腺活检中的组织学炎症模式。
我们回顾了 1999 年 1 月至 2011 年 2 月期间在我们机构接受诊断性加≥1 次经直肠超声引导活检的 AS 男性的记录。对每位患者的活检进行了粗略的炎症浸润类型和程度的回顾，并由一名病理学家进行了评分。使用重复测量混合模型评估炎症严重程度和重复活检次数之间的关系。使用未配对 t 检验和 χ(2)-平方分析评估炎症程度和炎症位置相对于癌症分级进展（定义为 Gleason 总和增加）的差异。
56 名男性符合研究纳入标准。平均年龄为 62.1（6.5）岁，71%为 cT1c 期，79%的 PSA 水平<10ng/ml(-1)，98%的诊断性 Gleason 总和≤6。随着重复活检次数的增加，最大慢性炎症（CI）评分出现了小的、具有统计学意义的增加。CI 评分与升级状态无关。本研究的主要局限性是样本量小。潜在的未测量混杂因素，如未报告的抗生素使用或有症状的前列腺炎，也可能影响了我们的发现。
在这项针对局部前列腺癌接受 AS 治疗的 56 名男性的试点研究中，随着前列腺活检次数的增加，慢性组织学炎症的程度增加，但与随后的分级进展风险无关。
