Raviv G, Janssen T, Zlotta A R, Descamps F, Verhest A, Schulman C C
Department or Urology, Erasme Hospital, University Clinics of Brussels, Belgium.
J Urol. 1996 Sep;156(3):1050-4; discussion 1054-5. doi: 10.1016/s0022-5347(01)65699-4.
We attempted to characterize patients diagnosed with prostatic intraepithelial neoplasia without concurrent cancer on biopsy who had prostate cancer on subsequent biopsy.
The records of 93 patients with low and high grade prostatic intraepithelial neoplasia without concurrent cancer on initial biopsy were analyzed. The relationships among prostatic intraepithelial neoplasia grades, patient age, digital rectal examination, serum prostate specific antigen (PSA), transrectal ultrasound appearance and final pathological results were investigated.
Subsequent carcinoma was found on repeat biopsy in 13.3% of patients with low grade and 47.9% with high grade prostatic intraepithelial neoplasia (p < 0.001). In the former group digital rectal examination, patient age, serum PSA and transrectal ultrasound were not predictive of cancer. Transrectal ultrasound appearance, digital rectal examination and serum PSA were statistically different between high grade prostatic intraepithelial neoplasia with and without subsequent cancer (p < 0.001, p = 0.008 and p = 0.016, respectively, univariate analysis). On multivariate analysis of patients with high grade prostatic intraepithelial neoplasia only digital rectal examination and PSA were predictive of subsequent carcinoma.
High grade prostatic intraepithelial neoplasia is a strong predictor of subsequent cancer, especially in men with abnormal digital rectal examination and elevated serum PSA. Patients with high grade prostatic intraepithelial neoplasia should undergo repeat biopsy to exclude cancer. Further investigations are needed to optimize the treatment of patients with low grade prostatic intraepithelial neoplasia.
我们试图对活检时诊断为前列腺上皮内瘤变且无并发癌症，但随后活检发现患有前列腺癌的患者进行特征描述。
分析了93例初次活检时患有低级别和高级别前列腺上皮内瘤变且无并发癌症患者的记录。研究了前列腺上皮内瘤变级别、患者年龄、直肠指检、血清前列腺特异性抗原（PSA）、经直肠超声表现与最终病理结果之间的关系。
在低级别前列腺上皮内瘤变患者中，13.3%在重复活检时发现后续癌变；在高级别前列腺上皮内瘤变患者中，这一比例为47.9%（p<0.001）。在前一组中，直肠指检、患者年龄、血清PSA和经直肠超声均不能预测癌症。高级别前列腺上皮内瘤变伴或不伴后续癌症患者的经直肠超声表现、直肠指检和血清PSA在统计学上存在差异（单因素分析中，p分别为<0.001、0.008和0.016）。对高级别前列腺上皮内瘤变患者进行多因素分析时，仅直肠指检和PSA可预测后续癌变。
高级别前列腺上皮内瘤变是后续发生癌症的有力预测指标，尤其是在直肠指检异常和血清PSA升高的男性中。高级别前列腺上皮内瘤变患者应接受重复活检以排除癌症。需要进一步研究以优化低级别前列腺上皮内瘤变患者的治疗。
