Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Systemic Immune-Inflammation Index Can Predict Clinically Significant Prostate Cancer in Patients with Atypical Small Acinar Proliferation: Descriptive Study
Sistemik İmmün-İnflamasyon İndeksi, Atipik Küçük Asiner Proliferasyonu Olan Hastalarda Klinik Olarak Anlamlı Prostat Kanserini Öngörebilir: Tanımlayıcı Çalışma
Serkan YENİGÜRBÜZa , Caner EDİZa , Serkan AKANb , Yunus Emre KIZILKANc , Suna ŞAHİN EDİZd , Ömer YILMAZa
aClinic of Urology, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
bClinic of Urology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Türkiye
cClinic of Urology, Bingöl State Hospital, Bingöl, Türkiye
dClinic of Radiology, Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
J Reconstr Urol. 2023;13(3):88-94
doi: 10.5336/urology.2023-98043
Article Language: EN
Full Text
ABSTRACT
 Objective: Atypical small acinar proliferations (ASAP) is defined as lesion without adequate histological atypia to be diagnosed as prostate cancer (PCa) upon prostate biopsy. The main purpose of this study was to investigate the markers that can predict clinically significant (cs)- PCa before a re-biopsy in patients with ASAP. Material and Methods: 2,845 cases were performed prostate biopsy due to elevated prostate-specific antigen (PSA) level and/or significant digital rectal examination findings in our clinic between January 2008 and May 2019 were evaluated. In 238 of 2,295 prostate biopsy patients ASAP was revealed and 130 cases whose data were reached taken into the study. Results: 78 (60%) patients were reported as benign and 52 (40%) had PCa after re-biopsy. The f/t PSA ratio was 0.21 and 0.17 in benign and malign groups (p=0.001). There was a significant difference in the systemic immune-inflammation (SII) values between patients with an International Society of Urology Pathology (ISUP) grade 1 and those with an ISUP grade ≥2 (p=0.03) Additionally, there was a statistically significant difference in SII values between Group 1 and patients with an ISUP grade ≥2 (p=0.027). However, there were no significant differences between the groups in the total-PSA, PSA density, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values. Conclusion: ASAP is a well-defined risk factor for PCa. An examination of SII marker before second biopsy may prove to be an active factor in predicting the cs-PCa diagnosis. Early diagnosis and treatment of csPCa will make a positive contribution to management protocols of the disease.

Keywords: Biopsy; prostate; prostatic neoplasms
ÖZET
 Amaç: Atipik küçük asiner proliferasyonlar (ASAP); prostat biyopsisi sonrası prostat adenokarsinom tanısını koyabilmek için yeterli miktarda histolojik atipisi olmayan lezyon olarak tanımlanmaktadır. Çalışmanın ana amacı; ilk biyopsisi ASAP gelen hastaların re-biyopsi öncesinde klinik anlamlı prostat kanserini (PKa) öngörebilecek belirteç varlığının araştırılması ve klinik kullanıma koyulmasıdır. Gereç ve Yöntemler: Ocak 2008-Mayıs 2019 tarihleri arasında kliniğimizde prostat spesifik antijen (PSA) yüksekliği ve/veya anlamlı parmakla rektal muayene bulguları nedeniyle prostat biyopsisi yapılan 2.845 olgu değerlendirildi. 2.295 hastanın patoloji sonucuna ulaşılabildi ve ASAP olan 238 hastanın 130'unun verilerine ulaşılabildi ve çalışmaya alındı. Bulgular: ASAP sonuçlanan ilk biyopsi ardından hastalara yapılan ikinci biyopsinin 78?i (%60) benign ve 52?si (%40) PKa olarak raporlandı. f/t PSA değeri 1. grupta ortalama 0,21 iken 2. grupta 0,17 olarak daha düşük hesaplandı ve gruplar arasındaki bu fark istatistiksel olarak anlamlı bulundu (p=0,001). Uluslararası Ürolojik Patoloji Derneği (ISUP) derecesi 1 olan hastalar ile ISUP derecesi ≥2 olan hastalar arasında sistemik immün inflamasyon (SII) değerlerinde anlamlı fark vardı (p=0,03). Ayrıca benign patolojisi olan hastaların yer aldığı Grup 1 ile ISUP derecesi ≥2 olan hastaların SII değerleri arasında istatistiksel olarak anlamlı fark vardı (p=0,027). Gruplar arasında total-PSA, PSA dansitesi, nötrofil-lenfosit ve trombosit-lenfosit oranı değerleri arasında anlamlı fark bulunmadı. Sonuç: ASAP, PKa için iyi tanımlanmış bir risk faktörüdür. İkinci biyopsiden önce SII belirtecinin incelenmesi, klinik anlamlı PKa teşhisini öngörmede aktif bir faktör olabilir. Klinik anlamlı PKa?nın erken teşhis ve tedavisi şüphesiz ki hastalığın yönetimine olumlu katkı sağlayacaktır.

Anahtar Kelimeler: Biyopsi; prostat; prostatik neoplazm
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