Zlota A r, Sattar A A, Wespes E, Noel J C, Schulman C C
Deartment of Urology, University of Clinics of Brussels, Erasme University Hospital, Belgium.
Urology. 1996 Mar;47(3):329-34. doi: 10.1016/s0090-4295(99)80448-8.
Individual differences in proportion of stroma, epithelium, and luminal space components prostatic hyperplasia (BPH) may explain the differences in clinical outcome of the patients treated with alpha-reductase inhibitors or alpha-blocking agents and other alternative treatments. Knowledge of the individual proportions of these elements may orient the clinician toward different therapeutic approaches. To determine whether a single prostate biopsy is representative of the whole adenoma, using quantitative morphometry, we have compared the percentage of smooth muscle cells and glandular cells in one prostate needle biopsy and in the corresponding prostate adenoma removed by open surgery.
Quantification was made using a computerized image analysis system and immunohistochemical staining (actin antiactin for the smooth muscle cells and anti-prostate-specific antigen (PSA) for the epithelial cells) in 14 patients who underwent retropubic prostatectomy.
Mean percentage of smooth muscle fibers, glandular epithelium, and glandular lumina in the prostate biopsy were, respectively, 34% (range, 20% to 42%, SD 5.9), 29% (range, 13% to 42%, SD 7.2), and 20% (range, 13% to 30%, SD 4.8). In the corresponding prostate adenoma, they were, respectively, 38% (range, 28% to 45%, SD 4.7), 32% (range, 25% to 40%, SD 4.5), and 19% (range, 13% to 34%, SD 6.1). The mean percentages of epithelial or glandular cells in the prostate biopsy and the corresponding adenoma were not statistically different (P > 0.05), whereas those for the smooth muscle cell percentage were different (P = 0.02). However, a statistically significant correlation between the whole adenoma and the needle biopsy sample was found in the percentage of smooth muscle cells (P = 0.028). Analyzing the morphometric data in conjunction with the serum PSA level and the volume of the adenoma, we found a statistically significant positive correlation between the volume of the adenoma and the ratio (percentage of epithelial cells/serum PSA level) (P = 0.009, r = 0.67).
Major differences are found in the primary tissue composition of different hyperplastic prostates. Computerized histologic quantification of the different components of BPH in the entire adenoma and a needle biopsy demonstrate that a single prostate biopsy is representative of the entire prostate adenoma. Morphometric data from a single biopsy of the prostate adenoma in combination with the serum PSA level and the volume of the prostate adenoma could therefore help to orient medical treatment of BPH by patient selection based on the knowledge of the distribution of the various components of BPH.
前列腺增生（BPH）中基质、上皮和管腔空间成分的比例存在个体差异，这可能解释了接受α-还原酶抑制剂或α-阻滞剂及其他替代治疗的患者临床结局的差异。了解这些成分的个体比例可能会引导临床医生采用不同的治疗方法。为了确定单次前列腺活检是否能代表整个腺瘤，我们使用定量形态计量学方法，比较了1例前列腺穿刺活检与开放手术切除的相应前列腺腺瘤中平滑肌细胞和腺细胞的百分比。
对14例行耻骨后前列腺切除术的患者，使用计算机图像分析系统和免疫组织化学染色（平滑肌细胞用抗肌动蛋白，上皮细胞用抗前列腺特异性抗原（PSA））进行定量分析。
前列腺活检中平滑肌纤维、腺上皮和腺管腔的平均百分比分别为34%（范围20%至42%，标准差5.9）、29%（范围13%至42%，标准差7.2）和20%（范围13%至30%，标准差4.8）。在相应的前列腺腺瘤中，它们分别为38%（范围28%至45%，标准差4.7）、32%（范围25%至40%，标准差4.5）和19%（范围13%至34%，标准差6.1）。前列腺活检和相应腺瘤中上皮或腺细胞的平均百分比无统计学差异（P>0.05），而平滑肌细胞百分比有差异（P=0.02）。然而，在平滑肌细胞百分比方面，整个腺瘤与穿刺活检样本之间存在统计学显著相关性（P=0.028）。结合血清PSA水平和腺瘤体积分析形态计量学数据，我们发现腺瘤体积与比率（上皮细胞百分比/血清PSA水平）之间存在统计学显著正相关（P=0.009，r=0.67）。
不同增生性前列腺的主要组织组成存在显著差异。对整个腺瘤和穿刺活检中BPH不同成分进行计算机组织学定量分析表明，单次前列腺活检可代表整个前列腺腺瘤。因此，结合血清PSA水平和前列腺腺瘤体积，对前列腺腺瘤进行单次活检获得的形态计量学数据，有助于根据BPH各成分分布的知识，通过患者选择来指导BPH的药物治疗。
