Ⅳ型前列腺炎炎症分级和范围与前列腺特异性抗原之间的关系

目的:探讨Ⅳ型前列腺炎炎症组织病理学分级和范围与前列腺特异性抗原(PSA)的关系。方法:对120例临床可疑前列腺癌患者采用B超引导下经会阴前列腺穿刺病理活检,排除前列腺癌及不合并炎症的前列腺增生病例,仅BPH合并前列腺炎病例入选,采用NIH-Ⅳ型前列腺炎组织病理学分类方法对每例患者标本按炎症位置、范围和分级3方面分3级比较,评价炎症与血清PSA的关系。结果:120例患者中BPH合并前列腺炎症46例。①组织病理学炎症范围分级,1级35例,2级7例,3级4例,tPSA分别为(8.46±4.09)μg/L、(15.26±5.26)μg/L和(21.05±7.58)μg/L,fPSA分别为(1.75±0.93)μg/L、(2.54±0.72)μg/L和(3.19±1.13)μg/L,PSAD分别为0.15±0.11、0.26±0.07和0.42±0.19。三级之间比较tPSA(P=0.001)、fPSA(P=0.008)和PSAD(P<0.001)差异均具有显著性。②组织病理学炎症分级,1级32例,2级10例,3级4例。tPSA分别为(8.37±4.07)μg/L、(13.30±5.69)μg/L和(21.05±7.58)μg/L。fPSA分别为(1.76±0.93)μg/L、(3.27±2.21)μg/L和(3.19±1.13)μg/L。PSAD分别为0.14±0.11、0.25±0.06和0.42±0.19。三级之间比较tPSA(P=0.002)、fPSA(P=0.024)和PSAD(P<0.001)差异均有显著性。③组织病理学炎症位置分级,1级19例,2级17例,3级10例,三级之间tPSA、fPSA、%fPSA差异均无显著性(P>0.05)。④组织病理学炎症范围与tPSA(r=0.6,P<0.001)、fPSA(r=0.5,P=0.001)和PSAD(r=0.6,P<0.001)呈显著正相关关系。组织病理学炎症分级与tPSA(r=0.5,P<0.001)、fPSA(r=0.4,P=0.008)和PSAD(r=0.7,P<0.001)呈显著正相关关系,与%fPSA呈显著负相关关系(r=-0.4,P=0.013)。结论:无症状前列腺炎症患者组织病理学炎症的分级和范围与血PSA显著相关,病理医生应对前列腺穿刺标本进行炎症描述,其对高分级前列腺炎症患者可避免反复活检。

Aggressiveness and extent of prostatic inflammation relates with serum PSA levels in type IV prostatitis

Objective: To investigate the relationship of the histopathologic grade and extent of prostatic inflammation with the level of serum PSA in patients with type Ⅳ prostatitis.Methods: We performed transrectal ultrasound-guided prostate biopsy for 120 patients suspected of prostate cancer and included in this study only those with benign prostate hyperplasia(BPH) and prostatitis(n = 46),excluding the cases with prostate cancer and those with BPH but no prostatitis.We evaluated the relationship between prostatic inflammation and serum PSA levels based on the three-grade pathohistologic criteria for the extent,location and aggressiveness of prostatic inflammation.The serum tPSA levels,fPSA levels,%fPSA,and PSAD were compared among different groups.Results: As for the extent of inflammation,35 of the 46 included cases were grade Ⅰ(tPSA: [8.46±4.09] μg/L;fPSA: [1.75±0.93] μg/L;PSAD: 0.15±0.11),7 were grade Ⅱ(tPSA: [15.26±5.26] μg/L;fPSA: [2.54±0.72] μg/L;PSAD: 0.26±0.07) and 4 were grade Ⅲ(tPSA: [21.05±7.58] μg/L;fPSA: [3.19±1.13] μg/L;PSAD: 0.42±0.19),with statistically significant differences among the three groups in the levels of tPSA(P=0.001),fPSA(P=0.008) and PSAD(P<0.001).Regarding the location of inflammation,19 cases were grade Ⅰ,17 were grade Ⅱ and 10 were grade Ⅲ,with no significant differences in tPSA,fPSA and %fPSA among the three grades(P>0.05).As for the aggressiveness of inflammation,32 cases were grade Ⅰ(tPSA: [8.37±4.07] μg/L;fPSA: [1.76±0.93] μg/L;PSAD: 0.14±0.11),10 were grade Ⅱ(tPSA: [13.30±5.69] μg/L;fPSA: [3.27±2.21] μg/L;PSAD: 0.25±0.06) and 4 were grade Ⅲ(tPSA: [21.05±7.58] μg/L;fPSA: [3.19±1.13] μg/L;PSAD: 0.42±0.19),with statistically significant differences among the three grades in the levels of tPSA(P=0.002),fPSA(P=0.024) and PSAD(P<0.001).The extent of inflammation was positively correlated with the levels of tPSA(r=0.6,P<0.001),fPSA(r=0.5,P=0.001) and PSAD(r=0.6,P<0.001),and so was the aggressiveness of inflammation(tPSA: r=0.5,P<0.001;fPSA: r=0.4,P=0.008;PSAD: r= 0.7,P<0.001),but a negative correlation was found between the aggressiveness of inflammation and %fPSA(r=-0.4,P=0.013).Conclusion: The aggressiveness and extent of prostatic inflammation in asymptomatic prostatitis patients are significantly correlated with the level of serum PSA,which may help pathologists to avoid unnecessary repeated biopsies for patients with high-grade prostatitis.