Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.
Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.
BJU Int. 2022 May;129(5):627-633. doi: 10.1111/bju.15568. Epub 2021 Aug 25.
To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies.
A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and who underwent repeat biopsy within 1 to 3 years, was analysed. Pre-repeat biopsy mpMRI and guided biopsies to suspicious lesions (Prostate Imaging - Reporting and Data System [PI-RADS] ≥3) and/or and systematic biopsies were performed. Persistent prostate cancer (PCa) suspicion, defined as sustained serum prostate-specific antigen level >4 ng/mL and/or abnormal digital rectal examination, was present in 248 men (84.6%), and was absent in 45 men (15.4%). A control group of 190 men who had no previous HGPIN, atypical small acinar proliferation or HGPIN with atypia who were scheduled to undergo repeat biopsy due to persistent PCa suspicion were also analysed. csPCa was defined as tumours of Grade Group ≥2.
In the subset of 45 men with isolated HGPIN, in whom PCa suspicion disappeared, only one csPCa (2.2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34.7% of men with persistent PCa suspicion and previous HGPIN, and in 28.4% of those without previous HGPIN (P =0.180). iPCa was detected in 12.1% and 6.3%, respectively (P =0.039). Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN: odds ratio (OR) 1.369 (95% confidence interval [CI] 0.894-2.095; P =0.149); however, previous HGPIN increased the risk of iPCa detection: OR 2.043 (95% CI 1.016-4.109; P =0.006).
The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.
分析重复活检中孤立性高级别前列腺上皮内瘤变（HGPIN）对临床显著前列腺癌（csPCa）检测的当前预测价值。
分析了 293 名男性的队列，这些男性在没有多参数磁共振成像（mpMRI）的情况下进行了先前的活检，并且在 1 至 3 年内进行了重复活检。进行了重复活检前的 mpMRI 和可疑病变的引导活检（前列腺成像报告和数据系统[PI-RADS]≥3）和/或系统活检。248 名男性（84.6%）存在持续的前列腺癌（PCa）可疑，定义为持续血清前列腺特异性抗原水平>4ng/mL 和/或异常数字直肠检查，45 名男性（15.4%）不存在。还分析了 190 名无先前 HGPIN、非典型小腺泡增生或 HGPIN 伴非典型的男性，这些男性由于持续的 PCa 可疑而计划进行重复活检，这些男性也被纳入对照组。csPCa 定义为肿瘤分级组≥2 级。
在 45 名 HGPIN 孤立的男性中，在 PCa 可疑性消失的情况下，仅检测到 1 例 csPCa（2.2%）和 1 例非显著 PCa（iPCa）。在持续的 PCa 可疑性和先前 HGPIN 的男性中，csPCa 的检出率为 34.7%，在没有先前 HGPIN 的男性中，csPCa 的检出率为 28.4%（P=0.180）。分别检测到 iPCa 的 12.1%和 6.3%（P=0.039）。逻辑回归分析显示，先前的 HGPIN 并不能预测 csPCa 的检出风险：比值比（OR）1.369（95%置信区间[CI]0.894-2.095；P=0.149）；然而，先前的 HGPIN 增加了 iPCa 的检出风险：OR 2.043（95%CI 1.016-4.109；P=0.006）。
在 HGPIN 孤立且 PCa 可疑性消失的男性中，csPCa 的风险极低。此外，在那些 PCa 可疑性持续存在的男性中，先前的 HGPIN 发现并不能影响 csPCa 的风险。然而，先前的 HGPIN 增加了 iPCa 的检出风险。因此，不能仅仅因为先前有 HGPIN 就推荐进行重复前列腺活检。
