Prostate Atypia: Does Repeat Biopsy Detect Clinically Significant Prostate Cancer?
Prostate Atypia: Does Repeat Biopsy Detect Clinically Significant Prostate Cancer?
复制标题
DOI：
10.1002/pros.22950
复制
发表时间：
2015-05-15
期刊：
影响因子：
2.8
通讯作者：
Wagner, Joseph R.
中科院分区：
文献类型：
--
作者：
Dorin, Ryan P.;Wiener, Scott;Wagner, Joseph R.
背景：虽然良性或恶性前列腺活检的治疗途径已经确立，但在前列腺癌异型性的初步诊断中，后续诊断前列腺癌的风险仍不确定。因此，我们调查了首次活检诊断为前列腺癌(PCa)的患者中重复活检诊断前列腺癌(PCA)的可能性。方法我们回顾了我们前瞻性维护的前列腺活检数据库，以确定1987年11月至2011年3月期间诊断非典型性(非典型小腺泡增殖；ASAP)后一年内再次接受前列腺癌活检的患者。排除有前列腺癌病史的患者。图表回顾确定了接受根治性前列腺切除术(RP)、放射治疗(RT)或主动监测(AS)的患者。在一些分析中，患者根据他们的服务日期被分成两个亚组。结果在1987年11月至2011年3月期间，720名患者接受了13,595次活组织检查。567例(5.3%)患者在初次活检时出现ASAP，其中287例(50.1%)在一年内进行了重复活检。其中122例(42.5%)为阴性，44例(15.3%)为不典型，19例(6.6%)为前列腺上皮内瘤变，102例(35.6%)为前列腺癌。根据改良的Epstein标准，重复活检的PCa患者中有27例(51%)被确定为具有临床意义的肿瘤。37例(36.3%)接受放射治疗，25例(24.5%)接受放疗，40例(39.2%)未立即接受治疗。在接受手术的患者中，11例(35.5%)最终病理的Gleason分级提高，1例(3.2%)患者的Gleason分级降低。结论在随后接受明确局部治疗的患者中，初次活检时的SASAP与重复活检时发生前列腺癌的风险显著相关。ASAP患者应咨询临床上有显着性和无显着性前列腺癌的可能性。前列腺癌75：673-678,2015。(C)2015年威利期刊公司。
BackgroundWhile the treatment pathway in response to benign or malignant prostate biopsies is well established, there is uncertainty regarding the risk of subsequently diagnosing prostate cancer when an initial diagnosis of prostate atypia is made. As such, we investigated the likelihood of a repeat biopsy diagnosing prostate cancer (PCa) in patients in which an initial biopsy diagnosed prostate atypia.METHODSWe reviewed our prospectively maintained prostate biopsy database to identify patients who underwent a repeat prostate biopsy within one year of atypia (atypical small acinar proliferation; ASAP) diagnosis between November 1987 and March 2011. Patients with a history of PCa were excluded. Chart review identified patients who underwent radical prostatectomy (RP), radiotherapy (RT), or active surveillance (AS). For some analyses, patients were divided into two subgroups based on their date of service.RESULTSTen thousand seven hundred and twenty patients underwent 13,595 biopsies during November 1987-March 2011. Five hundred and sixty seven patients (5.3%) had ASAP on initial biopsy, and 287 (50.1%) of these patients underwent a repeat biopsy within one year. Of these, 122 (42.5%) were negative, 44 (15.3%) had atypia, 19 (6.6%) had prostatic intraepithelial neoplasia, and 102 (35.6%) contained PCa. Using modified Epstein's criteria, 27/53 (51%) patients with PCa on repeat biopsy were determined to have clinically significant tumors. 37 (36.3%) proceeded to RP, 25 (24.5%) underwent RT, and 40 (39.2%) received no immediate treatment. In patients who underwent surgery, Gleason grade on final pathology was upgraded in 11 (35.5%), and downgraded 1 (3.2%) patient.CONCLUSIONSASAP on initial biopsy was associated with a significant risk of PCa on repeat biopsy in patients who subsequently underwent definitive local therapy. Patients with ASAP should be counseled on the probability of harboring both clinically significant and insignificant prostate cancer. Prostate 75:673-678, 2015. (c) 2015 Wiley Periodicals, Inc.