Reply by the Authors

Abstract

The main argument of the letter is on the exclusion of studying separately the entity of proliferative inflammatory atrophy (PIA). It is well established that clinical prostatitis may lead to PSA elevations; however, there are conflicting studies as to whether only histologic evidence of either acute or chronic inflammation on biopsy correlates with increase in total serum PSA levels. Pathologists comment on the histologic presence of chronic inflammation only when it is prominent. Otherwise, as it is fairly ubiquitous, almost every report could mention its presence. 1 Epstein J.I. Netto G.J. Biopsy Interpretation of the Prostate. in: 4th ed. Wolters Kluwer, Lippincott Williams and Wilkins, Philadelphia, PA2008: 23 Google Scholar In our study no patient had symptomatic prostatitis and there was no case with intense inflammation. To grade inactive chronic inflammation, we used a modified classification proposed by Nickel et al's 2 Nickel J.C. True L.D. Krieger J.N. et al. Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU Int. 2001; 87: 797-805 Crossref PubMed Google Scholar slight (individual inflammatory cells, most of which are separated by distinct intervening spaces), moderate (confluent sheets of inflammatory cells with no tissue destruction or lymphoid nodule/follicle formation), and intense (confluent sheets of inflammatory cells with tissue destruction or nodule/follicle formation). The cut-off point between group A and B in this study was based on the median PSA level of 8.2 ng/mL, which was different from the median value of 7.5 ng/mL of the previous study because of more extended biopsies in this cohort of patients. The number of cores examined for each biopsy ranged from 7 to 18 (mean and median, 9.4 and 8 cores, respectively). In our institution we do not perform saturation biopsies routinely, because they did not show to be superior for the detection of prostate cancer in comparison with the standard 8-12 core biopsies. Re: Billis et al.: Does the Type of Prostatic Atrophy Influence the Association of Extent of Atrophy in Needle Biopsies and Serum Prostate-specific Antigen Levels? (Urology 2009;74:1111-1115)UrologyVol. 75Issue 5PreviewWe read with great interest the article by Billis et al,1 who based on their older findings2 of a positive/significant association between the extent of prostatic atrophy and serum prostate-specific antigen (PSA) levels in patients with biopsies revealing only atrophy, assessed possible correlation with the type of atrophy. They concluded that there was no correlation to the type of atrophy; that is, partial atrophy, simple atrophy, hyperplastic atrophy (postatrophic hyperplasia), and sclerotic atrophy. Full-Text PDF