高级别前列腺上皮内瘤患者血清PSA特征及再次穿刺时发展为前列腺癌的风险

Features of serum PSA in patients with HGPIN and the risk of cancer development in subsequent biopsy

目的探讨高级别前列腺上皮内瘤(high grade prostatic intraepithelial neoplasia,HGPIN)患者血清PSA特征及首次穿刺活检HGPIN阳性针数对再次活检前列腺癌(prostate cancer,PCa)检出率的影响。方法对492例疑为PCa患者行经直肠超声引导下前列腺穿刺活检,穿刺方法为8+X法。穿刺活检结果:PCa 186例,孤立型HGPIN(仅1针活检病理为HGPIN)34例,多灶型HGPIN(2针及以上活检病理为HGPIN)13例,低级别前列腺上皮内瘤(low grade prostatic intraepithelial neoplasia,LGPIN)64例,前列腺增生(benign prostatic hyperplasia,BPH)195例,分析比较各组间血清PSA的相关性及差异。6个月后对多灶型HGPIN和孤立型HGPIN患者行再次穿刺活检,不管其血清PSA水平变化,同时对LGPIN和BPH患者血清PSA水平升高或者持续不降者行再次穿刺活检,分析比较各组中PCa的检出率。结果 LGPIN与BPH组间血清PSA水平差异无统计学意义(P>0.05),孤立型HGPIN与LGPIN组间血清PSA水平差异无统计学意义(P>0.05),孤立型HGPIN与BPH组间血清PSA水平差异无统计学意义(P>0.05),多灶型HGPIN与LGPIN组间血清PSA水平差异有统计学意义(P<0.05),多灶型HGPIN与BPH组间血清PSA水平差异有统计学意义(P<0.05),多灶型HGPIN与孤立型HGPIN组间血清PSA水平差异有统计学意义(P<0.05)。再次穿刺活检,多灶型HGPIN组中再次穿刺活检PCa的检出率为38.46%,孤立型HGPIN组为9.68%,LGPIN组为12.50%,BPH组为12.20%。结论孤立型HGPIN患者血清PSA特征倾向于BPH,多灶型HGPIN患者血清PSA水平介于BPH和PCa之间,多灶型HGPIN患者再次活检PCa的检出率显著高于孤立型HGPIN及BPH。

Purpose To investigate the serum prostate specific antigen（ PSA）feature of high grade prostatic intraepithelial neoplasia （ HGPIN）patients,and the association of the number of cores positive for HGPIN on initial biopsy and the risk of cancer development in second biopsy. Methods 492 cases of patients with suspicious prostate cancer were scheduled for transrectal ultrasound prostatic biopsy with an 8-core template. In the first biopsy,l86 cases of patients with PCa,34 cases of patients with isolated HGPIN（ only one core involved with HGPIN）and 13 cases of patients with extensive HGPIN（ two or more cores involved with HGPIN）,64 cases of pa-tients with LGPIN,195 cases of patients with BPH. The values of PSA were analyzed and compared within these groups. In patients with extensive HGPIN or isolated HGPIN we proposed a repeat 8-core biopsy after 6 months independent of serum PSA level. The same measure was applied for patients diagnosed as LGPIN or BPH in the first biopsy with accompanying increase or persistent elevation of serum PSA level. The incidence of PCa was analyzed and compared within these groups. Results The serum PSA levels were no sig-nificantly different between LGPIN and BPH（P〉0. 05）,between isolated HGPIN and LGPIN（P〉0. 05）,and between isolated HG-PIN and BPH（P〉0. 05）. The serum PSA levels were significantly different between extensive HGPIN and LGPIN（P〈0. 05）,be-tween extensive HGPIN and BPH（P〈0. 05）,and between extensive HGPIN and isolated HGPIN（P〈0. 05）. In the second biopsy, the incidence of PCa in patients with extensive HGPIN was 38. 48%,that in patients with isolated HGPIN was 9. 68%,that in patients with LGPIN was 12.50%,and that in patients with BPH was 12. 20%. Conclusions The features of PSA in patients with isolated HGPIN are similar to BPH,PSA level in patients with extensive HGPIN were between PCa and BPH,and patients with extensive HG-PIN have a higher incidence of PCa in second biopsy than isolated HGPIN and BPH.