Freitas Daniel M, Andriole Gerald L, Castro-Santamaria Ramiro, Freedland Stephen J, Moreira Daniel M
Institute of Urology, University of Southern California, Los Angeles, CA.
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
Urology. 2017 May;103:161-166. doi: 10.1016/j.urology.2016.12.027. Epub 2016 Dec 23.
To evaluate whether baseline prostate atrophy (PA) extent is associated with prostate cancer (PCa) incidence at 2-year repeat prostate biopsy in a clinical trial with systematic biopsies.
We performed a retrospective analysis of 3165 men 50-75 years old with prostate-specific antigen between 2.5 and 10 ng/mL and a prior negative biopsy in the placebo arm of the Reduction by Dutasteride of PCa Events trial who underwent a 2-year repeat biopsy. PA extent was defined as the percentage of cores with atrophic changes. The association of baseline PA with positive 2-year biopsies was evaluated with logistic regression in uni- and multivariable analysis, controlling for baseline covariates.
PA involving none, 1%-25%, 26%-50%, 51%-75%, and >75% of the baseline cores was observed in 966 of 3165 (30.5%), 1189 of 3165 (37.6%), 677 of 3165 (21.4%), 209 of 3165(6.6%), and 124 of 3165 (3.9%) cases, respectively. More extensive PA was associated with older age, lower prostate-specific antigen, larger prostate volume, and higher prevalence of acute and chronic inflammations (all P < .05). Compared to subjects without PA, those with 1%-25%, 26%-50%, 51%-75%, and >75% core involvement had an odds ratio for PCa of 0.65 (95% confidence interval [CI] = 0.52-0.81), 0.60 (95% CI = 0.46-0.78), 0.56 (95% CI = 0.37-0.86), and 0.35 (95% CI = 0.19-0.67), respectively. In multivariable analysis, the extent of PA was independently associated with lower PCa risk (P < .001). More extensive PA was associated with lower incidence of low-grade (Gleason 2-6) and high-grade (Gleason 7-10) PCa.
The extent of baseline PA is independently associated with lower PCa risk in a dose-dependent fashion.
在一项进行系统性活检的临床试验中，评估基线前列腺萎缩（PA）程度与2年重复前列腺活检时前列腺癌（PCa）发病率之间的关联。
我们对3165名年龄在50 - 75岁、前列腺特异性抗原水平在2.5至10 ng/mL之间且之前在度他雄胺降低PCa事件试验的安慰剂组活检结果为阴性的男性进行了回顾性分析，这些男性接受了2年重复活检。PA程度定义为有萎缩性改变的活检芯组织的百分比。在单变量和多变量分析中，采用逻辑回归评估基线PA与2年活检阳性结果之间的关联，并对基线协变量进行控制。
在3165例病例中，分别观察到无PA、1% - 25%、26% - 50%、51% - 75%和>75%的基线活检芯组织受累的情况，各有966例（30.5%）、1189例（37.6%）、677例（21.4%）、209例（6.6%）和124例（3.9%）。更广泛的PA与年龄较大、前列腺特异性抗原水平较低、前列腺体积较大以及急慢性炎症患病率较高相关（所有P <.05）。与无PA的受试者相比，PA累及1% - 25%、26% - 50%、51% - 75%和>75%活检芯组织的受试者发生PCa的比值比分别为0.65（95%置信区间[CI] = 0.52 - 0.81）、0.60（95% CI = 0.46 - 0.78）、0.56（95% CI = 0.37 - 0.86）和0.35（95% CI = 0.19 - 0.67）。在多变量分析中，PA程度与较低的PCa风险独立相关（P <.001）。更广泛的PA与低级别（Gleason 2 - 6）和高级别（Gleason 7 - 10）PCa的较低发病率相关。
基线PA程度以剂量依赖方式与较低的PCa风险独立相关。
