Abstract
BackgroundHigh-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor lesion to prostate cancer (CaP). UK-based studies examining the occurrence of isolated HGPIN and subsequent risk of CaP are lacking. Our aim was to assess the occurrence of HGPIN in a regional UK population and to determine whether in a retrievable cohort of such patients that had repeat extended core biopsies, there was an elevated risk of CaP.MethodsA retrospective analysis of the pathology database was conducted at our institution (Lancashire Teaching Hospitals NHS Foundation Trust) for prostate biopsies recorded between January 2001 and December 2005 (all extended core biopsies). Those patients with isolated HGPIN on 1st set of biopsies were identified and, their clinical characteristics and pathological findings from subsequent biopsies (if any) were determined. The risk of CaP on subsequent biopsies based on presenting baseline PSA was stratified.ResultsOf 2,192 biopsied patients, there were 88 cases of isolated HGPIN of which 67 patients underwent one or more repeat biopsies. In this repeat-biopsy group, 28 CaP diagnoses were made. Age at first biopsy (P < 0.001), higher mean baseline prostate-specific antigen (PSA) (P < 0.005) and higher mean change in PSA (P < 0.05) were predictive of CaP detection on repeat biopsies. PSA ranges and their associated predictive values for cancer were: 0 to 5 ng/ml – 11%; 5 to 10 ng/ml – 34%; 10 to 20 ng/ml – 50%; and > 20 ng/ml – 87.5%.ConclusionBased on our results, we recommend delaying the 1st repeat biopsy at low PSA range but to have a shorter interval to repeat biopsies at intermediate and higher PSA ranges.
Highlights
High-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor lesion to prostate cancer (CaP)
A further sub-group analysis looking at the subsequent risk of CaP based on the level of presenting prostate-specific antigen (PSA) was performed to determine whether the risk was purely due to HGPIN or possibly due to concurrent CaP that was not biopsied at the time of 1st biopsy
A Kaplan-Meier type estimator plot was generated using GraphPad Prism software (Version 4) based on this PSA sub-group data; diagnosis of CaP was assessed as the endpoint of interest. During this period, extended core needle prostate biopsies were performed in a cohort of 2,087 men, of which 88 men (4.2%) had isolated HGPIN and 972 (46.6%) were diagnosed with CaP
Summary
High-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor lesion to prostate cancer (CaP). UK-based studies examining the occurrence of isolated HGPIN and subsequent risk of CaP are lacking. Studies prior to the mid-1990s that examined cancer risk on subsequent prostate biopsies after diagnosis of isolated HGPIN showed a 27% to 100% elevated risk. Some studies cast doubt on whether isolated HGPIN is associated with a high risk of CaP on repeat biopsies [5,7,8]. Reduced rates of CaP detection on repeat biopsies have been attributed to widespread prostate-specific antigen (PSA) screening resulting in early, small-volume cancer at diagnosis, and adoption of extended core biopsy techniques that sample more extensively the lateral regions of the prostate [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
