Davidson D, Bostwick D G, Qian J, Wollan P C, Oesterling J E, Rudders R A, Siroky M, Stilmant M
Nichols Laboratories, Lincoln, Nebraska, USA.
J Urol. 1995 Oct;154(4):1295-9.
High grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic adenocarcinoma. However, the natural history and predictive value of prostatic intraepithelial neoplasia for cancer are unknown.
To examine the predictive value of high grade prostatic intraepithelial neoplasia, we conducted a retrospective clinic based comparative study of 100 patients with high grade prostatic intraepithelial neoplasia and 112 without prostatic intraepithelial neoplasia on needle biopsies matched for digital rectal examination findings, patient age and serum prostate specific antigen level. Only patients who had 1 or more followup biopsies were included.
Adenocarcinoma was identified in 35% of subsequent biopsies from patients with prostatic intraepithelial neoplasia, compared with 13% of control biopsies. The likelihood of finding cancer increased as the interval from initial biopsy increased. High grade prostatic intraepithelial neoplasia, patient age and serum prostate specific antigen concentration were jointly highly significant predictors of cancer, with prostatic intraepithelial neoplasia providing the highest risk ratio of 14.93 (95% confidence intervals 5.6 to 39.8). No other candidate predictor was significant, including digital rectal examination findings, transrectal ultrasound results, amount of prostatic intraepithelial neoplasia on biopsy and architectural pattern of prostatic intraepithelial neoplasia.
These results indicate that the presence of high grade prostatic intraepithelial neoplasia on needle biopsy is strongly predictive of carcinoma. Prostatic intraepithelial neoplasia should be reported in needle biopsies and biopsy repeated. These finding support the hypothesis that prostatic intraepithelial neoplasia is a precursor of prostate cancer.
高级别前列腺上皮内瘤变被认为是前列腺腺癌最可能的前驱病变。然而，前列腺上皮内瘤变的自然病史及其对癌症的预测价值尚不清楚。
为了研究高级别前列腺上皮内瘤变的预测价值，我们进行了一项基于临床的回顾性比较研究，对100例经针吸活检确诊为高级别前列腺上皮内瘤变的患者和112例未发生前列腺上皮内瘤变的患者进行了比较，这些患者的直肠指检结果、年龄和血清前列腺特异性抗原水平相匹配。仅纳入了有1次或更多次随访活检的患者。
前列腺上皮内瘤变患者后续活检中有35%发现腺癌，而对照活检中这一比例为13%。随着距初次活检时间间隔的增加，发现癌症的可能性增大。高级别前列腺上皮内瘤变、患者年龄和血清前列腺特异性抗原浓度共同成为癌症的高度显著预测因素，其中前列腺上皮内瘤变的风险比最高，为14.93（95%置信区间5.6至39.8）。包括直肠指检结果、经直肠超声检查结果、活检中前列腺上皮内瘤变的数量以及前列腺上皮内瘤变的结构模式在内的其他候选预测因素均无显著意义。
这些结果表明，针吸活检中存在高级别前列腺上皮内瘤变对癌具有很强的预测性。针吸活检时应报告前列腺上皮内瘤变情况并重复活检。这些发现支持了前列腺上皮内瘤变是前列腺癌前驱病变的假说。
