Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere; Department of Pathology, Seinäjoki Central Hospital, Seinäjoki.
BJU Int. 2013 Oct;112(6):735-41. doi: 10.1111/bju.12153. Epub 2013 Jun 7.
To assess whether histological signs of inflammation are associated with an increased risk of subsequent prostate cancer (PCa) in men with elevated serum prostate-specific antigen (PSA) concentrations and benign initial biopsy.
Study subjects were men aged 54-67 years with an elevated PSA (≥4 ng/mL or 3-4 ng/mL and free to total PSA ratio ≤0.16 or positive digital rectal examination), but a benign biopsy result within the Finnish population-based randomised screening trial for PCa, which started in 1996. A total of 293 prostate biopsies without PCa or suspicion of malignancy from the first screening round in the Tampere centre were re-evaluated by a uropathologist to assess histological inflammation. Results of the subsequent screening rounds were obtained from the trial database and PCa diagnoses made outside the screening were obtained from the Finnish Cancer Registry. The median length of follow-up was 10.5 years. Cox regression analysis was used to assess PCa risk after the initial benign biopsy.
Histological inflammation was found in 66% of the biopsies. Subjects with inflammation at the biopsy had a slightly lower PCa risk in the second screening round (18 vs 27%, rate ratio 0.69, 95% confidence interval [CI] 0.35-1.34) relative to men without inflammation. In further follow-up, the PCa risk remained nonsignificantly lower (hazard ratio [HR] 0.71, CI 0.46-1.10; P = 0.13). The risk was not appreciably affected by adjustment for age, PSA, prostate volume and family history of PCa (HR 0.67, CI 0.42-1.07; P = 0.092).
Histological inflammation in a prostate biopsy among men with an initial false-positive screening test was not associated with an increased risk of subsequent PCa, but instead with a decreased risk which was of borderline significance. Inflammation in prostate biopsy is not a useful risk indicator in PCa screening.
评估血清前列腺特异性抗原（PSA）浓度升高且初次活检良性的男性中，炎症的组织学表现是否与前列腺癌（PCa）发生风险增加相关。
研究对象为年龄在 54-67 岁之间的男性，他们的 PSA 升高（≥4ng/ml 或 3-4ng/ml 且游离 PSA 与总 PSA 比值≤0.16 或直肠指检阳性），但在芬兰基于人群的 PCa 筛查试验中，初次活检为良性。共 293 例来自坦佩雷中心首次筛查的无 PCa 或恶性肿瘤可疑的前列腺活检，由泌尿科医师重新评估组织学炎症。从试验数据库中获得后续筛查轮次的结果，并从芬兰癌症登记处获得筛查外的 PCa 诊断。中位随访时间为 10.5 年。使用 Cox 回归分析评估初次良性活检后的 PCa 风险。
66%的活检存在组织学炎症。与无炎症的男性相比，炎症活检组在第二轮筛查时的 PCa 风险略低（18%比 27%，发生率比 0.69，95%置信区间 [CI] 0.35-1.34）。在进一步随访中，PCa 风险仍然无显著降低（风险比 [HR] 0.71，CI 0.46-1.10；P = 0.13）。通过调整年龄、PSA、前列腺体积和 PCa 家族史，风险无明显变化（HR 0.67，CI 0.42-1.07；P = 0.092）。
初次假阳性筛查试验中，前列腺活检中的组织学炎症与随后发生的 PCa 风险增加无关，而是与风险降低相关，但该结果具有边界显著性。前列腺活检中的炎症不是 PCa 筛查的有用风险指标。
