Wiener Scott, Haddock Peter, Cusano Joe, Staff Ilene, McLaughlin Tara, Wagner Joseph
Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
Urology. 2017 Dec;110:161-165. doi: 10.1016/j.urology.2017.08.040. Epub 2017 Sep 6.
To assess the incidence of clinically significant and insignificant prostate cancer after an initial biopsy that revealed either atypical small acinar proliferation (ASAP), high-grade prostatic intraepithelial neoplasia (HGPIN), or benign tissue.
We retrospectively identified patients diagnosed with ASAP, HGPIN, or benign tissue who had a repeat prostate biopsy within 1 year of diagnosis during 1987-2015. We compared the incidence of any prostate cancer and clinically significant prostate cancer (based on Gleason score, prostate-specific antigen (PSA), number of positive cores, and core volume) for each diagnostic group.
A total of 17,016 biopsies were performed in 12,817 patients during 1987-2015. Among the 615 patients who had a repeat biopsy within 1 year of their first, 261 (42.4%), 208 (33.8%), and 146 (23.8%) had ASAP, HGPIN, or benign tissue on the initial biopsy, respectively. The second biopsy demonstrated significant differences in prostate cancer detection rates between these 3 groups (34.1%, 20.2%, and 15.8%, respectively; P <.001), with cancer detected significantly more often in the ASAP group relative to other groups (P <.001 vs benign and P = .001 vs HGPIN). The rates of clinically significant prostate cancer did not differ between groups (8.0%, 6.7%, and 4.1%, respectively, P = .31).
On repeat biopsy, rates of clinically significant prostate cancer did not differ between patients initially diagnosed with ASAP, HGPIN, or benign tissue. Elevated rates of prostate cancer after a diagnosis of ASAP appear to be largely due to differences in the rate of clinically insignificant disease.
评估初次活检显示非典型小腺泡增生（ASAP）、高级别前列腺上皮内瘤变（HGPIN）或良性组织后，具有临床意义和无临床意义的前列腺癌的发生率。
我们回顾性地确定了1987年至2015年期间诊断为ASAP、HGPIN或良性组织且在诊断后1年内进行了重复前列腺活检的患者。我们比较了每个诊断组中任何前列腺癌和具有临床意义的前列腺癌（基于Gleason评分、前列腺特异性抗原（PSA）、阳性核心数量和核心体积）的发生率。
1987年至2015年期间，共对12,817例患者进行了17,016次活检。在首次活检后1年内进行重复活检的615例患者中，分别有261例（42.4%）、208例（33.8%）和146例（23.8%）在初次活检时发现ASAP、HGPIN或良性组织。第二次活检显示这3组之间前列腺癌检出率存在显著差异（分别为34.1%、20.2%和15.8%；P <.001），ASAP组中检测到癌症的频率明显高于其他组（与良性组相比P <.001，与HGPIN组相比P =.001）。具有临床意义的前列腺癌发生率在各组之间没有差异（分别为8.0%、6.7%和4.1%，P =.31）。
在重复活检时，最初诊断为ASAP、HGPIN或良性组织的患者中，具有临床意义的前列腺癌发生率没有差异。诊断为ASAP后前列腺癌发生率升高似乎主要是由于无临床意义疾病发生率的差异。
