Ferguson J, Zincke H, Ellison E, Bergstrahl E, Bostwick D G
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Urology. 1994 Jul;44(1):91-5. doi: 10.1016/s0090-4295(94)80015-4.
Prostatic intraepithelial neoplasia (PIN) is considered the most likely precursor of prostatic adenocarcinoma. The effect of androgen deprivation therapy on the prevalence of PIN is unknown.
We undertook a case-control study of radical retropubic prostatectomies from 24 treated patients and a control group of 24 untreated patients matched for age and clinical stage (all T3). Androgen deprivation therapy included LHRH agonist leuprolide and flutamide (18 patients), diethylstilbestrol (DES) (2 patients), DES with leuprolide and flutamide (1 patients), and orchiectomy (3 patients). Prostatectomy specimens were evaluated for the presence and extent of high-grade PIN according to the number of high-power microscopic fields, and nuclear tumor grade (1 to 4 scale) and Gleason score were also determined.
The prevalence of high-grade PIN in pretreatment transrectal needle biopsies was similar in the treated and untreated groups. The prevalence and extent of high-grade PIN were lower in cases treated with androgen deprivation therapy than controls. Nuclear tumor grade was also lower in treated patients, but there was a paradoxical increase in the Gleason score. The prevalence of aneuploidy in the cancers was similar in both groups.
These findings suggest that androgen deprivation therapy decreases the prevalence and extent of high-grade PIN.
前列腺上皮内瘤变（PIN）被认为是前列腺腺癌最可能的前驱病变。雄激素剥夺疗法对PIN患病率的影响尚不清楚。
我们对24例接受治疗的患者行耻骨后根治性前列腺切除术进行了病例对照研究，并与24例年龄和临床分期（均为T3）匹配的未治疗患者组成的对照组进行比较。雄激素剥夺疗法包括促性腺激素释放激素（LHRH）激动剂亮丙瑞林和氟他胺（18例患者）、己烯雌酚（DES）（2例患者）、DES联合亮丙瑞林和氟他胺（1例患者）以及睾丸切除术（3例患者）。根据高倍显微镜视野数量评估前列腺切除标本中高级别PIN的存在情况和范围，并确定核肿瘤分级（1至4级）和Gleason评分。
治疗组和未治疗组治疗前经直肠穿刺活检中高级别PIN的患病率相似。接受雄激素剥夺疗法的病例中高级别PIN的患病率和范围低于对照组。治疗患者的核肿瘤分级也较低，但Gleason评分却出现矛盾性升高。两组癌症中异倍体的患病率相似。
这些发现表明雄激素剥夺疗法可降低高级别PIN的患病率和范围。
