Keetch D W, Humphrey P, Stahl D, Smith D S, Catalona W J
Division of Urologic Surgery, Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St. Louis, Missouri, USA.
J Urol. 1995 Aug;154(2 Pt 1):347-51. doi: 10.1097/00005392-199508000-00003.
We evaluate the significance of grade and extent of isolated prostatic intraepithelial neoplasia in prostate needle biopsies as a predictor of cancer on repeat biopsy.
We reviewed our experience with 58 men 50 years or older who had isolated prostatic intraepithelial neoplasia on initial prostate needle biopsy during a prostate specific antigen (PSA) based screening trial for prostate cancer. All 58 men underwent repeat biopsy to follow the initial findings of prostatic intraepithelial neoplasia. We assessed the relationship of patient age, digital rectal examination, serum PSA concentration, PSA density, prostatic intraepithelial neoplasia grade, number of foci of neoplasia and linear extent of prostatic intraepithelial neoplasia in the initial biopsy specimen to the finding of cancer on the repeat biopsy. We also compared the cancer detection rate in the 58 men with and 427 without prostatic intraepithelial neoplasia in the same screening trial.
Of 21 men with low grade and 37 with high grade prostatic intraepithelial neoplasia 4 (19%) and 19 (51%), respectively, had cancer on repeat biopsy (p < 0.02), compared to 82 of 427 (19%) without cancer or prostatic intraepithelial neoplasia on the initial biopsy. High grade prostatic intraepithelial neoplasia was a significant predictor of malignancy on repeat biopsy (p < 0.05). The number of foci of neoplasia and the linear extent of prostatic intraepithelial neoplasia on initial biopsy were not predictive of cancer on repeat biopsy.
Our results demonstrate that the presence of high grade prostatic intraepithelial neoplasia is a strong predictor of prostate cancer in men with elevated serum PSA concentrations and they should be followed with repeat biopsy.
我们评估前列腺穿刺活检中孤立性前列腺上皮内瘤变的分级和范围作为重复活检时癌症预测指标的意义。
我们回顾了在一项基于前列腺特异性抗原（PSA）的前列腺癌筛查试验中，58名年龄在50岁及以上、初次前列腺穿刺活检发现孤立性前列腺上皮内瘤变的男性患者的情况。所有58名男性均接受了重复活检，以追踪前列腺上皮内瘤变的初始检查结果。我们评估了患者年龄、直肠指检、血清PSA浓度、PSA密度、初次活检标本中前列腺上皮内瘤变的分级、瘤变灶数量以及前列腺上皮内瘤变的线性范围与重复活检时癌症发现情况之间的关系。我们还比较了在同一筛查试验中，这58名有前列腺上皮内瘤变的男性与427名无前列腺上皮内瘤变的男性的癌症检出率。
在21名低级别和37名高级别前列腺上皮内瘤变的男性中，重复活检时分别有4名（19%）和19名（51%）发现癌症（p<0.02），而在初次活检时无癌症或前列腺上皮内瘤变的427名男性中，有82名（19%）发现癌症。高级别前列腺上皮内瘤变是重复活检时恶性肿瘤的显著预测指标（p<0.05）。初次活检时瘤变灶数量和前列腺上皮内瘤变的线性范围不能预测重复活检时的癌症。
我们的结果表明，高级别前列腺上皮内瘤变的存在是血清PSA浓度升高男性患前列腺癌的有力预测指标，应对他们进行重复活检随访。
