Abstract
High grade prostatic intraepithelial neoplasia (HGPIN) is widely regarded as the precancerous. The aim of this study was to determine PSA related parameters in patients with initial PSA values 2-10 ng/mL and diagnosis of HGPIN without finding carcinoma at the time of their first needle biopsy. Study groups consisted of 100 men who were diagnosed HGPIN, 84 with cancer and 183 with benign hyperplasia on first biopsy of prostate. Total PSA and free PSA were measured and ratio free/total PSA and PSA density calculated. Mean values of these parameters were compared, and receiver operating characteristic curves were used for comparison of PSA related parameters to discriminate groups of patients.Total PSA, free PSA level and PSA density in patients with HGPIN (6.388 ng/mL) did not differ significantly compared to prostate carcinoma (6.976 ng/mL) or benign prostatic hyperplasia (6.07 ng/mL) patients. Patients with HGPIN had significantly higher ratio free/total PSA than those with prostate carcinoma (0.168 vs 0.133), but significantly lower than patients with benign prostatic hyperplasia (0.168 vs 0.185). Ratio of free/total PSA significantly discriminate HGPIN from prostate carcinoma with sensitivity 84.52 and specify 45.00 at cut-off point of ≤ 0.18. Values of PSA, free PSA and ratio free/total PSA in cases of HGPIN appear to be intermediate between prostate cancer and normal levels. Ratio of free/total PSA may help in decision to repeat biopsies in the presence of HGPIN on biopsy, without concomitant prostate cancer, in patients suitable for curative treatment, with normal digito-rectal examination and trans-rectal sonography.
Highlights
High-grade prostatic intraepithelial neoplasia (HGPIN) is proliferation of highly atypical cells within the pre-existing prostatic acini and ducts [1]
Receiver operating characteristic curves were used for comparison of PSA related parameters to discriminate patients with prostate carcinoma (PCa), HGPIN and benign prostate hyperplasia (BPH)
The greatest area under the curve was observed for R free PSA (fPSA)/PSA both between PCa and HGPIN and PCa and BPH (0.658 and 0.682 respectively)
Summary
High-grade prostatic intraepithelial neoplasia (HGPIN) is proliferation of highly atypical cells within the pre-existing prostatic acini and ducts [1]. HGPIN shows no specificity on digital rectal examination (DRE) and transrectal ultrasonography (TRUS) [2, 3]. The natural biological behavior of HGPIN is yet poorly understood, but it is considered as a precursor of prostate cancer and is frequently associated with it. HGPIN is found in 85% of radical prostatectomies performed for prostate carcinoma. HGPIN in prostate biopsy is a risk factor for detection of prostate carcinoma in subsequent biopsies with the incidence ranges from 21% to 73% [4, 5, 6, 7]. Atypical small acinar proliferation (ASAP) adjacent to HGPIN seems to confer an even
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