MP86-02 PREDICTIVE VALUE OF PATHOLOGIC PARAMETERS AND ERG ONCOPROTEIN EXPRESSION IN THE STRATIFICATION OF PROSTATE CANCER RISK ASSOCIATED WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN) DIAGNOSIS IN PROSTATE NEEDLE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening VII1 Apr 2015MP86-02 PREDICTIVE VALUE OF PATHOLOGIC PARAMETERS AND ERG ONCOPROTEIN EXPRESSION IN THE STRATIFICATION OF PROSTATE CANCER RISK ASSOCIATED WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN) DIAGNOSIS IN PROSTATE NEEDLE BIOPSY Rajal Shah and Savvas Mendrinos Rajal ShahRajal Shah More articles by this author and Savvas MendrinosSavvas Mendrinos More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1911AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES HGPIN diagnosis in prostate needle biopsy (NBX) has traditionally been associated with high predictability of finding a cancer (PCa) in repeat biopsy (∼40%); however, the diagnosis rates of PCa after an initial diagnosis of HGPIN have significantly decreased in recent years (∼25%) as more aggressive biopsy templates have reduced the number of cancers missed on initial biopsy. However, there is still considerable heterogeneity in practices regarding management of HGPIN. Which patients with the HGPIN diagnosis should be biopsied remain a clinical management dilemma. ERG is a highly PCa specific marker that is present in ∼50% of prostate carcinomas (PCas) and ∼20% of high-grade prostatic intraepithelial neoplasia (HGPIN) that intermingle with PCa. METHODS 107 patients with HGPIN in initial biopsy and at least one follow-up biopsy were included. Clinicopathologic features including age, serum PSA, number of cores with HGPIN, laterality of involvement and presence or absence of ERG overexpression by immunostaining (IHC) were analyzed in order to identify parameters that correlate with subsequent detection of PCa. RESULTS The mean age was 63 years (range, 46 - 83). The repeat biopsy was performed at mean of 5.5 months (range, 1 - 26). A mean of 10.5 and 10.8 cores for initial and repeat biopsy were obtained (range, 6 - 24). Twenty five (23%) had cancer, 9 (8.4%) had HGPIN, and 73 (68%) had benign diagnosis on repeat biopsy. ERG expression was present in 9 (8%) HGPIN patients; PCa was found in 7 (77%) subsequent biopsies. Of 98 biopsies with negative ERG staining, PCa was found in 16 (15%) subsequent biopsies. Of 25 patients with subsequent cancer diagnosis, 14 (56%) had >1 site with HGPIN and 11 (44%) had bilateral involvement. Of 82 patients with no cancer on follow-up repeat biopsy, 32 (39%) had >1 site with HGPIN and 12 (15%) had bilateral disease. Only 6 (6%) patients with single site (core) with HGPIN had PCa on repeat biopsy. The combination of > 1 core with HGPIN and/or bilateral involvement with ERG positivity was associated with the presence of PCa in 100% of repeat biopsies. CONCLUSIONS Our preliminary results support utility of the ERG IHC along with pathological parameters to tailor management of patients with HGPIN on the initial biopsy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1075 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajal Shah More articles by this author Savvas Mendrinos More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...