Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
Division of Pathology, Città della Salute e della Scienza - Molinette Hospital, Turin, Italy.
Scand J Urol. 2021 Apr;55(2):129-134. doi: 10.1080/21681805.2020.1866659. Epub 2021 Jan 7.
To evaluate the premalignant potential of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP).
Patients diagnosed with monofocal HGPIN (mHGPIN), widespread HGPIN (≥4 cores, wHGPIN) and/or ASAP who underwent at least one rebiopsy during their follow-up, were enrolled. All enrollment biopsies underwent central pathologic revision. Risks for PCa were estimated using Fine and Gray method for competing risk.
Pathologic revision changed the original diagnosis in 32.3% of cases. Among 336 cases enrolled, PCa was diagnosed in 164 (48.8%), and more specifically in 20 (30.3%) mHGPIN, 10 (34.5%) wHGPIN, 101 (54.0%) ASAP, and 33 (61.1%) HGPIN + ASAP (mean follow-up 124 months). Most PCa were Gleason score 6(3 + 3) (51.0%) and 7(3 + 4) (34.3%). On multivariate analysis, HGPIN + ASAP (HR 2.76, < 0.001) and ASAP alone (HR 2.41, < 0.001) were the only lesions significantly associated with PCa development. Of all cancers detected, 64.3% were at first rebiopsy. A rebiopsy performed within 3 months after ASAP diagnosis had a 45% chance of finding PCa. At Kaplan-Meier survival curves, median PCa-free survival was 48.1 months for HGPIN + ASAP and 64.9 months for ASAP ( 0.0005 at Log-rank test). At 1 year, 70% of HGPIN + ASAP, 73% of ASAP, 89% of wHGPIN, and 84% of mHGPIN were PCa-free.
The diagnosis of ASAP and HGPIN strongly relies on the expertise of dedicated uro-pathologists. Finding of ASAP is a strong risk factor for a subsequent PCa diagnosis, advising a rebiopsy, possibly within 3 months. m/wHGPIN should not be routinely rebiopsied.
评估高级别前列腺上皮内瘤变（HGPIN）和非典型小腺泡增生（ASAP）的癌前潜能。
本研究纳入了诊断为单灶 HGPIN（mHGPIN）、广泛 HGPIN（≥4 个核心，wHGPIN）和/或 ASAP 且在随访期间至少接受过一次再次活检的患者。所有入组活检均进行中心病理复查。使用 Fine 和 Gray 法对竞争风险进行估计，以评估前列腺癌的风险。
病理复查改变了 32.3%病例的原始诊断。在 336 例入组患者中，诊断为前列腺癌的有 164 例（48.8%），具体为 20 例 mHGPIN（30.3%）、10 例 wHGPIN（34.5%）、101 例 ASAP（54.0%）和 33 例 HGPIN+ASAP（平均随访 124 个月）。大多数前列腺癌为 Gleason 评分 6（3+3）（51.0%）和 7（3+4）（34.3%）。多变量分析显示，HGPIN+ASAP（HR 2.76，<0.001）和 ASAP 单独存在（HR 2.41，<0.001）是与前列腺癌发展唯一显著相关的病变。在所有检测到的癌症中，64.3%在第一次再次活检时发现。在 ASAP 诊断后 3 个月内进行再次活检，有 45%的机会发现前列腺癌。在 Kaplan-Meier 生存曲线中，HGPIN+ASAP 的中位无前列腺癌生存时间为 48.1 个月，ASAP 为 64.9 个月（Log-rank 检验 P=0.0005）。在 1 年时，HGPIN+ASAP 的无前列腺癌率为 70%，ASAP 为 73%，wHGPIN 为 89%，mHGPIN 为 84%。
ASAP 和 HGPIN 的诊断强烈依赖于专门的泌尿病理学家的专业知识。ASAP 的发现是后续前列腺癌诊断的一个强烈危险因素，建议进行再次活检，可能在 3 个月内进行。m/wHGPIN 不应常规进行再次活检。
