前列腺上皮内瘤的临床意义及处理

Clinical Significance and Management of Prostatic Intraepithelial Neoplasia

前列腺上皮内瘤 (PIN)是前列腺导管、小管及腺泡上皮细胞的异常增生。PIN分为Ⅰ、Ⅱ、Ⅲ级 ,Ⅰ级为低分级PIN ,Ⅱ和Ⅲ级为高分级PIN。临床上诊断为PIN是指高分级PIN ,低分级PIN不作为独立的病理诊断。高分级PIN被认为是前列腺癌的癌前病变。在流行病学、基因学、病理形态学、发生的部位及临床特点等 ,高分级PIN与前列腺癌都很相似 ,两者密切相关。高分级PIN是病理诊断 ,前列腺的直肠指检及B超检查无特异性 ,多数学者认为高分级PIN患者血清PSA并不升高 ,高分级PIN患者的血清PSA升高者 ,要考虑高分级PIN与前列腺癌共同存在的可能性。高分级PIN的处理尚无一致认同的意见 ,目前多数认为多针穿刺活检诊断为单纯高分级PIN的患者 ,可不进行任何治疗 ,但要定期随访复查 ,对PSA值升高或B超检查有异常改变者 ,再行穿刺活检。目前对高分级PIN的生物学行为所知甚少 ,多数学者不主张对单纯高分级PIN患者采用抗雄激素治疗。

Prostatic intraepithelial neoplasia (PIN) refers to the cellular proliferations within prostatic ducts, ductules, and acini. PIN is divided into three grades, PIN 1, PIN 2 and PIN 3, PIN 1 is a low grade (LPIN); PIN 2 and PIN 3 are high grades (HPIN). Clinically, the term PIN is usually used to indicate HPIN. LPIN is not used as a separate pathological diagnostic entity. HPIN is widely regarded as the precancerous change of prostatic carcinoma. HPIN and prostatic carcinoma share many similarities in epidemiology, genetics, morphology, as well as in location and clinical features. And so they are two closely related enities. HPIN is pathologically diagnosed, and shows no specificity on digital rectal examination(DRE) and transrectal ultrasonagraphy(TRUS). HPIN does not elevate serum prostatic specific antigen (PSA) concentration. HPIN with an elevation of serum PSA should be considered as the possible coexistence of HPIN and prostatic carcinoma. There has been no consensus on the management of HPIN, but it is widely held that simple HPIN detected by extended needle biopsy has no therapeutic implications, but should be followed up at regular intervals. If there are changes in PSA and/or DRE, repeated needle biopsy is imperative. The natural biological behaviour of HPIN is yet poorly understood. Currently, most urological experts do not recommend antiandrogen therapy to patients with simple HPIN.