Intraprostatic inflammation is positively associated with serum PSA in men with PSA <4 ng ml(-1), normal DRE and negative for prostate cancer.
Intraprostatic inflammation is positively associated with serum PSA in men with PSA <4 ng ml(-1), normal DRE and negative for prostate cancer.
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DOI：
10.1038/pcan.2015.19
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发表时间：
2015-09
影响因子：
4.8
通讯作者：
Platz EA
中科院分区：
文献类型：
--
作者：
Umbehr MH;Gurel B;Murtola TJ;Sutcliffe S;Peskoe SB;Tangen CM;Goodman PJ;Thompson IM;Lippman SM;Lucia MS;Parnes HL;Drake CG;Nelson WG;De Marzo AM;Platz EA
针对血清 PSA 升高进行的活检常常显示炎症浸润。然而，对于无活检指征且前列腺癌阴性的男性，前列腺内炎症对血清 PSA 的影响尚未详细描述。我们研究了前列腺癌预防试验 (PCPT) 安慰剂组中的 224 名男性，他们按照试验方案接受了研究结束活检，PSA<4 ng/mL，直肠指检正常，活检癌症呈阴性。我们分析了平均包含 3 个活检核心的 H&E 染色载玻片的数据。炎症测量包括所检查的整个组织区域中以及按组织隔室的总体、急性和慢性炎症的程度（有炎症的组织区域的百分比）和强度（程度和等级的分数的乘积）。我们通过活检前血清 PSA 三分位数计算了炎症的中位测量值（>0–≤0.8、>0.8–≤1.5、>1.5–<4.0 ng/mL）。我们使用调整活检年龄的线性回归估计了炎症组织面积百分比与 PSA 自然对数之间的关联。 PSA 三分位数中，炎症组织面积的中位百分比从 2% 增加到 5%，再增加到 9.5%（P 趋势<0.0001）。炎症组织面积每增加 5%，PSA 对数就会增加 0.061 ng/mL (P=0.0002)。急性炎症的管腔和上皮内区室以及慢性炎症的基质和上皮内区室中 PSA 三分位数的中位范围和强度评分均有所增加（所有 P 趋势≤0.05）。在临床上没有怀疑患有前列腺癌的男性中，更严重的整体炎症、管腔和上皮内急性炎症以及间质和上皮内慢性炎症与较高的血清 PSA 相关。
Biopsies performed for elevated serum PSA often show inflammatory infiltrates. However, the influence of intraprostatic inflammation on serum PSA in men without biopsy indication and negative for prostate cancer has not been described in detail. We studied 224 men in the placebo arm of the Prostate Cancer Prevention Trial (PCPT) who underwent end-of-study biopsy per trial protocol, had PSA<4 ng/mL, normal digital-rectal examination, and a biopsy negative for cancer. We analyzed data from H&E-stained slides containing a mean of 3 biopsy cores. Inflammation measures included the extent (percentage of tissue area with inflammation) and intensity (product of scores for extent and grade) of total, acute, and chronic inflammation in the entire tissue area examined, and by tissue compartment. We calculated median measures of inflammation by pre-biopsy serum PSA tertile (>0–≤0.8, >0.8–≤1.5, >1.5–<4.0 ng/mL). We estimated the association between percentage of tissue area with inflammation and natural logarithm of PSA using linear regression adjusting for age at biopsy. Median percentage of tissue area with inflammation increased from 2% to 5% to 9.5% across PSA tertiles (P-trend<0.0001). For every 5% increase in tissue area with inflammation, log PSA increased by 0.061 ng/mL (P=0.0002). Median extent and intensity scores increased across PSA tertiles in luminal and intraepithelial compartments for acute inflammation and in stromal and intraepithelial compartments for chronic inflammation (all P-trend≤0.05). In men without clinical suspicion of prostate cancer, greater overall inflammation, luminal and intraepithelial acute inflammation, and stromal and intraepithelial chronic inflammation were associated with higher serum PSA.