CAJ | 학술논문

目的：探讨高级别前列腺上皮内瘤（ high grade prostatic intraepithe1ia1 neop1asia，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（1ow grade prostatic intraepithe1ia1 neop1asia， LGPIN）64例，前列腺增生（ benign prostatic hyperp1asia，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。
목적：탐토고급별전렬선상피내류（ high grade prostatic intraepithe1ia1 neop1asia，HGPIN）환자혈청PSA특정급수차천자활검HGPIN양성침수대재차활검전렬선암（ prostate cancer，PCa）검출솔적영향。방법대492례의위PCa환자행경직장초성인도하전렬선천자활검，천자방법위8+X법。천자활검결과：PCa 186례，고립형HGPIN（부1침활검병리위HGPIN）34례，다조형HGPIN（2침급이상활검병리위HGPIN）13례，저급별전렬선상피내류（1ow grade prostatic intraepithe1ia1 neop1asia， LGPIN）64례，전렬선증생（ benign prostatic hyperp1asia，BPH）195례，분석비교각조간혈청PSA적상관성급차이。6개월후대다조형HGPIN화고립형HGPIN환자행재차천자활검，불관기혈청PSA수평변화，동시대LGPIN화BPH환자혈청PSA수평승고혹자지속불강자행재차천자활검，분석비교각조중PCa적검출솔。결과 LGPIN여BPH조간혈청PSA수평차이무통계학의의（P>0.05），고립형HGPIN여LGPIN조간혈청PSA수평차이무통계학의의（P>0.05），고립형HGPIN여BPH조간혈청PSA수평차이무통계학의의（P>0.05），다조형HGPIN여LGPIN조간혈청PSA수평차이유통계학의의（P<0.05），다조형HGPIN여BPH조간혈청PSA수평차이유통계학의의（ P<0.05），다조형HGPIN여고립형HGPIN조간혈청PSA수평차이유통계학의의（ P<0.05）。재차천자활검，다조형 HGPIN조중재차천자활검 PCa적검출솔위38.46%，고립형 HGPIN 조위9.68%，LGPIN조위12.50%，BPH조위12.20%。결론고립형HGPIN환자혈청PSA특정경향우BPH，다조형HGPIN환자혈청PSA수평개우BPH화PCa지간，다조형HGPIN환자재차활검PCa적검출솔현저고우고립형HGPIN급BPH。
Purpose To investigate the serum prostate specific antigen( PSA)feature of high grade prostatic intraepithe1ia1 neop1asia ( HGPIN)patients,and the association of the number of cores positive for HGPIN on initia1 biopsy and the risk of cancer deve1opment in second biopsy. Methods 492 cases of patients with suspicious prostate cancer were schedu1ed for transrecta1 u1trasound prostatic biopsy with an 8-core temp1ate. In the first biopsy,186 cases of patients with PCa,34 cases of patients with iso1ated HGPIN( on1y one core invo1ved with HGPIN)and 13 cases of patients with extensive HGPIN( two or more cores invo1ved with HGPIN),64 cases of pa-tients with LGPIN,195 cases of patients with BPH. The va1ues of PSA were ana1yzed and compared within these groups. In patients with extensive HGPIN or iso1ated HGPIN we proposed a repeat 8-core biopsy after 6 months independent of serum PSA 1eve1. The same measure was app1ied for patients diagnosed as LGPIN or BPH in the first biopsy with accompanying increase or persistent e1evation of serum PSA 1eve1. The incidence of PCa was ana1yzed and compared within these groups. Results The serum PSA 1eve1s were no sig-nificant1y different between LGPIN and BPH(P>0. 05),between iso1ated HGPIN and LGPIN(P>0. 05),and between iso1ated HG-PIN and BPH(P>0. 05). The serum PSA 1eve1s were significant1y different between extensive HGPIN and LGPIN(P<0. 05),be-tween extensive HGPIN and BPH(P<0. 05),and between extensive HGPIN and iso1ated HGPIN(P<0. 05). In the second biopsy, the incidence of PCa in patients with extensive HGPIN was 38. 48%,that in patients with iso1ated 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 iso1ated HGPIN are simi1ar to BPH,PSA 1eve1 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 iso1ated HGPIN and BPH.