慢性前列腺炎及多灶型HGPIN患者再次穿刺时发展为前列腺癌风险的研究

Development of prostate cancer risk in patients with chronic prostate inflammation and wHGPIN during puncture rebiopsy

目的探讨伴有慢性前列腺炎及多灶型高级别前列腺上皮内瘤(Widespread high grade prostatic intraepithelial neoplasia,wHGPIN)患者再次活检,发展为前列腺癌风险的研究。方法 2006年7月—2014年12月收集前列腺再次穿刺活检者172例,均为初次活检病理诊断为HGPIN者,穿刺为经直肠超声引导下前列腺12点穿刺法。再次穿刺均是在初次穿刺6个月后进行的。多灶型HGPIN界定为在前列腺活检中有2针及以上检出高级别前列腺上皮内瘤,孤立型HGPIN界定为在前列腺活检中有1针检出高级别前列腺上皮内瘤。结果初次活检172例HGPIN患者,孤立型HGPIN 102例,伴有慢性前列腺炎患者17例;多灶型HGPIN 70例,伴有慢性前列腺炎患者54例;172例HGPIN患者再次活检病理为前列腺腺癌者48例,多灶型HGPIN组检出率52.86%(37/70),孤立型HGPIN组检出率为10.78%(11/102),差异有统计学意义(P<0.001);多灶型HGPIN伴有慢性前列腺炎组前列腺腺癌检出率高于不伴有慢性前列腺炎组,差异有统计学意义(P=0.011)。经Logistic回归模型分析,慢性前列腺炎和多灶型HGPIN是再次活检为前列腺癌的独立风险因素。结论首次活检为慢性前列腺炎与多灶型HGPIN患者是再次活检为前列腺腺癌的高风险因素,建议超声引导下经直肠前列腺再次活检。

Objective The objective of this study was to investigate a risk of prostate cancer （PCa） at a repeat biopsy in patients with chronic prostate inflammation and widespread high grade prostatic intra epithelial neoplasia（ wHGPIN ） . Methods From July 2006 to December 2014,172 cases of prostate biopsy were collected. All of them were diagnosed as HGPIN for the first biopsy, punctured by transrectal ultrasound for 12 points. After the first puncture for 6 months, patients were punctured for rebiopsy. Multi - focal wHGPIN was defined as a high -grade prostate intraepithelial neoplasia with 2 or more cores detection in a prostate biopsy. Isolated HGPIN was defined as a high - grade prostate intraepithelial neoplasia with only one core detection in a prostate biopsy. Re-sults Seventy - two patients with HGPIN were isolated from primary HGPIN, 102 patients with isolated HGPIN, 17 patients with chronic prostatitis ,70 with multifocal HGPIN and 54 with chronic prostatitis. Forth - eight of 172 patients initial diagnosis of HGPIN was diagnosed as PCa at rebiopsy. The detection rate of wHGPIN was 52. 86% （37/70） and isolated HGPIN for 10. 88% （ 11/102） . They showed a statistically difference between two groups（P 〈0.001）. The detection rate of PCa in HGPIN patients with chronic prostatitis was higher than that in patients without chronic prostatitis（ P =0. 011）. Chronic prostatitis and multifocal wHGPIN were a risk factor for prostate cancer independent by rebiopsy, confirmed by the logistic regression model. Conclusion Rebiopsy is a high risk factor of prostate adenocarcinoma for patients with chronic prostatitis and multifocal HGPIN initially diagnosed by the first biopsy. Therefore, these patients are recommended under ultrasound induced by rectal prostate rebiopsy.