Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain; Research group in Urology. Vall d´Hebron Research Institute; Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.
Urol Oncol. 2021 Jul;39(7):432.e11-432.e19. doi: 10.1016/j.urolonc.2020.10.016. Epub 2020 Nov 5.
To assess the current ability of atypical small acinar proliferation (ASAP), multifocal high-grade prostatic intraepithelial neoplasia (mHGPIN), HGPIN with atypia (PINATYP) and other non-malignant lesions to predict clinically significant prostate cancer (csPCa) in repeat prostate biopsies.
This retrospective study analyzed 377 repeat prostate biopsies, carried out between 2.014 and 2.017, and excluding those with previous PCa or 5-alpha reductase inhibitors treatment. ASAP, mHGPIN, PINATYP, prostatic atrophy, prostatic hyperplastic atrophy, proliferative inflammatory atrophy (PIA), chronic prostatitis, acute prostatitis, or granulomatous prostatitis, were prospectively reported after 12-core transrectal ultrasound (TRUS) systematic negative previous biopsies. 3T-multiparametric magnetic resonance imaging (mpMRI) was performed previous repeat biopsies. At least 2-core TRUS targeted biopsies of Prostate Imaging-Reporting and Data Systemv2 lesions ≥3, and/or 12-core TRUS systematic biopsy were performed in repeat prostate biopsies. The main outcome measurements were csPCa detection, which was defined when the International Society of Uro-Pathology group grade >1 and avoided biopsies. After logistic regression analysis the most efficient model was selected, nomogram was designed with internal validation, and clinical utility was analyzed.
Normal benign tissue alone was present in less than 2% of previous negative biopsies. mHGPIN (39.7%), ASAP (4.3%) and PINATYP (3.7%) failed to predict csPCa risk in repeat biopsies. The finding of PIA (38.2%) associated with a decreased the risk of csPCa with an Odd ratio of 0.54 (95% confidence interval: 0.31-0.95), P= 0.031. The area under the curve, to predict csPCa, of mpMRI was 0.736, increasing up to 0.860 (95% confidence internal:0.82-0.90) when PSA density, age, digital rectal examination, and differential PSA between biopsies and PIA finding were integrated in a predictive model. At 6% threshold, more than 20% of repeat prostate biopsies were saved without missing csPCa.
Currently, mHGPIN in negative prostate biopsy seems not able to predict the risk of future csPCa. The low incidence of ASAP and PINATYP, in our series, did not allow us to draw conclusions. PIA finding associated with a reduced risk of csPCa, and it could be integrated in a useful based-mpMRI predictive nomogram.
评估非典型小腺泡增生（ASAP）、多灶性高级别前列腺上皮内瘤变（mHGPIN）、伴有非典型性的 HGPIN（PINATYP）和其他非恶性病变在重复前列腺活检中预测临床显著前列腺癌（csPCa）的能力。
本回顾性研究分析了 2014 年至 2017 年间进行的 377 例重复前列腺活检，排除了既往有前列腺癌或 5-α还原酶抑制剂治疗的病例。在 12 芯经直肠超声（TRUS）系统阴性活检后，前瞻性报告 ASAP、mHGPIN、PINATYP、前列腺萎缩、前列腺增生性萎缩、增生性炎症性萎缩（PIA）、慢性前列腺炎、急性前列腺炎或肉芽肿性前列腺炎。在重复前列腺活检中，进行了 3T 多参数磁共振成像（mpMRI）检查。对前列腺成像报告和数据系统 v2 病变≥3 的至少 2 芯 TRUS 靶向活检和/或 12 芯 TRUS 系统活检进行了重复前列腺活检。主要观察指标为 csPCa 检出率，定义为国际泌尿病理学会组分级>1 且避免活检的病例。通过逻辑回归分析选择最有效的模型，设计内部验证的列线图，并进行临床实用性分析。
既往阴性活检中，正常良性组织的比例不到 2%。mHGPIN（39.7%）、ASAP（4.3%）和 PINATYP（3.7%）在重复活检中未能预测 csPCa 风险。PIA（38.2%）的检出与 csPCa 风险降低相关，比值比为 0.54（95%置信区间：0.31-0.95），P=0.031。mpMRI 预测 csPCa 的曲线下面积为 0.736，当 PSA 密度、年龄、直肠指检、活检和 PIA 之间的 PSA 差异被整合到预测模型中时，增加到 0.860（95%置信区间：0.82-0.90）。当 PSA 密度、年龄、直肠指检、活检和 PIA 结果的 PSA 差异被整合到预测模型中时，PIA 发现可将重复前列腺活检的检出率提高到 0.860（95%置信区间：0.82-0.90）。在 6%的阈值下，超过 20%的重复前列腺活检可以在不遗漏 csPCa 的情况下进行。
目前，mHGPIN 在阴性前列腺活检中似乎不能预测未来 csPCa 的风险。在我们的研究中，ASAP 和 PINATYP 的发生率较低，因此无法得出结论。PIA 的发现与 csPCa 风险降低相关，可整合到有用的基于 mpMRI 的预测列线图中。
