穿刺活检报告高分级前列腺上皮内瘤的诊治

Diagnosis and treatment of high-grade prostatic intraepithelial neoplasm detected by needle biopsy

目的探讨前列腺穿刺活检报告为高分级前列腺上皮内瘤（HGPIN）病例的临床诊断和治疗措施。方法记录分析了7例首诊穿刺活检报告为HGPIN的患者资料并对该组所有患者进行规律随访,随访时间18～43个月。随访内容包括血PSA检测以及增加针数的10点前列腺穿刺。对随访中发现前列腺癌的病例实施根治手术治疗,对高度怀疑前列腺癌病例给与放射治疗,治疗后均作随访。结果7例患者中,1例患者于首诊时行前列腺癌根治术,术后标本病理仅报告HGPIN。3例随访29～43个月,未发现前列腺癌存在的证据,而未行特殊治疗。在随访过程中,2例证实前列腺癌而行前列腺癌根治术,术后分别随访24个月和36个月,均健在;1例行前列腺放射治疗,术后随访30个月健在,血PSA逐渐下降。结论HGPIN是前列腺癌的癌前病变,前列腺穿刺活检报告HGPIN的患者应给与严密随访。根据随访中血PSA和前列腺穿刺结果,必要时采取针对前列腺癌的治疗干预措施,以争取较好的预后。

Objective To investigate the diagnosis and treatment of high-grade prostatic intraepithelial neoplasm （HGPIN） detected by needle biopsy. Methods 7 cases diagnosed as HGPIN in the first needle biopsy were analyzed. All of the cases were performed with regular follow-up for 18～43 months. The follow-up examinations consist of serum PSA detection and augmented to 10-points needle biopsy. During the follow-up, when adenocarcinoma was identified by biopsy radical prostatectomies were performed, when prostatic carcinoma was highly-suspected then radiotherapy was applied. Results Of the 7 cases, 1 case received radical prostatectomies after the first biopsy, however, pathological diagnosis of prostate specimen was exclusively HGPIN. 3 cases were regularly followed up for 29～43 months, no treatment was performed for no carcinomatous evidences was acquired. During the follow-up, 2 cases were identified as adenocarcinoma by biopsy, radical prostatectomies were received and survived for 24 and 36 months respectively.One case who had received prostate radiotherapy was fine after 30 months with gradually decreasing serum PSA. Conclusion HGPIN is a precancerous change of prostatic carcinoma. When pathological diagnosis of needle biopsy is HGPIN, regularl close follow-up are suggested. According to the results of serum PSA and biopsy in follow-up, treatments should aim directly at prostatic carcinoma when necessary, in order to strive for good prognosis.