Widespread High-grade Prostatic Intraepithelial Neoplasia on Prostatic Needle Biopsy: A Significant Likelihood of Subsequently Diagnosed Adenocarcinoma
Widespread High-grade Prostatic Intraepithelial Neoplasia on Prostatic Needle Biopsy: A Significant Likelihood of Subsequently Diagnosed Adenocarcinoma
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DOI：
10.1097/01.pas.0000213324.97294.54
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发表时间：
2006-09
期刊：
影响因子：
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通讯作者：
G. Netto;J. Epstein
中科院分区：
文献类型：
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作者：
G. Netto;J. Epstein
与早期的研究相比，最近的报告表明，初次诊断为高级别前列腺上皮内瘤变 (HGPIN) 后，前列腺癌的发病率较低。后者导致了重新考虑在这种情况下再次活检的绝对必要性的普遍趋势。目前的回顾性研究评估了 41 名初步诊断为“广泛”HGPIN（定义为 4 个或更多活检核心中存在 HGPIN）的患者随后识别前列腺腺癌 (PCa) 的可能性。所有患者在 1 至 41 个月内至少接受 1 次随访 (F/U) 采样程序。 16/41 名患者 (39%) 发现 PCa，除 1 名患者在第一次 F/U 活检中发现外，其余患者在第一次 F/U 活检阴性后通过经尿道切除术确诊。除 1 例外，所有前列腺癌诊断均在初次活检后 2 年内获得，其中 10 例在第一年内诊断。平均而言，前列腺癌在 10.4 个月时被发现（范围：1 至 36 个月）。所有已发现的前列腺癌中有四分之一的格里森评分为 7 或更高。在另外 4 名患者 (9.7%) 中，F/U 活检显示 HGPIN 具有邻近的非典型小腺体，可疑但不能诊断为癌 (PINATYP)。在 41 名患者中，10 名 (24.3%) 继续显示 HGPIN，其余 11/41 名患者 (26.8%) 显示良性前列腺组织。与年轻患者相比，初次活检时年龄≥70岁的患者重复活检时 PCa 或 HGPIN/PINATYP 诊断率显着高于年轻患者 (P=0.02)，其中老年男性被诊断出癌症的比例为 55%，而年轻男性中这一比例为 33%。与 F/U 上的 HGPIN/PINATYP 相比，初次活检时取样较少的患者更有可能被诊断为癌症（P=0.015）。其他因素，如 F/U 手术次数、初次 HGPIN 活检前的血清前列腺特异性抗原水平、每次 F/U 活检的核心数量以及 F/U 间隔长度，并不影响发现癌症的可能性。总之，我们的研究表明，在初步诊断广泛 HGPIN 后获得的重复活检中发现 PCa 的风险为 39%。我们的研究结果支持对这部分患者进行重复活检的必要性。
In comparison with earlier studies, recent reports have demonstrated a lower incidence of prostate carcinoma after an initial diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN). The latter has led to a general tendency to reconsider the absolute need for a rebiopsy in this setting. The current retrospective study assesses the subsequent likelihood of identifying prostatic adenocarcinoma (PCa) in 41 patients with an initial diagnosis of “widespread” HGPIN defined as HGPIN present in 4 or more biopsy cores. All patients underwent at least 1 follow-up (F/U) sampling procedure in a period of 1 to 41 months. PCa was found in 16/41 patients (39%), all except 1 identified on the first F/U biopsy with the remaining patients diagnosed on a transurethral resection after a negative first F/U biopsy. All but 1 prostatic carcinoma diagnoses were obtained within 2 years from initial biopsy with 10 rendered within the first year. On average, prostate cancer was identified at 10.4 months (range: 1 to 36). One-fourth of all identified prostatic carcinomas were of Gleason score 7 or more. In 4 additional patients (9.7%), F/U biopsy revealed HGPIN with adjacent atypical small glands suspicious but not diagnostic of carcinoma (PINATYP). Of 41 patients, 10 (24.3%) continued to show HGPIN with the remaining 11/41 patients (26.8%) showing benign prostatic tissue. Patients ≥70 years of age at the time of initial biopsy had a statistically significant higher rate of PCa or HGPIN/PINATYP diagnosis on repeat biopsy compared with younger patients (P=0.02), with 55% of older men being diagnosed with cancer as compared with 33% in younger men. Patients with fewer cores sampled on initial biopsy were more likely to be diagnosed with carcinoma as opposed to HGPIN/PINATYP on F/U (P=0.015). Other factors such as the number of F/U procedures, serum prostate-specific antigen level before initial HGPIN biopsy, number of cores per F/U biopsy, and F/U interval length did not affect the likelihood of finding carcinoma. In summary, our study reveals a 39% risk of finding PCa on repeat biopsies obtained after an initial diagnosis of widespread HGPIN. Our findings support the need for a repeat biopsy in this subset of patients.