title: Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies.
abstract: OBJECTIVE
  High grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic adenocarcinoma. However, the natural history and predictive value of prostatic intraepithelial neoplasia for cancer are unknown.
  
  
  METHODS
  To examine the predictive value of high grade prostatic intraepithelial neoplasia, we conducted a retrospective clinic based comparative study of 100 patients with high grade prostatic intraepithelial neoplasia and 112 without prostatic intraepithelial neoplasia on needle biopsies matched for digital rectal examination findings, patient age and serum prostate specific antigen level. Only patients who had 1 or more followup biopsies were included.
  
  
  RESULTS
  Adenocarcinoma was identified in 35% of subsequent biopsies from patients with prostatic intraepithelial neoplasia, compared with 13% of control biopsies. The likelihood of finding cancer increased as the interval from initial biopsy increased. High grade prostatic intraepithelial neoplasia, patient age and serum prostate specific antigen concentration were jointly highly significant predictors of cancer, with prostatic intraepithelial neoplasia providing the highest risk ratio of 14.93 (95% confidence intervals 5.6 to 39.8). No other candidate predictor was significant, including digital rectal examination findings, transrectal ultrasound results, amount of prostatic intraepithelial neoplasia on biopsy and architectural pattern of prostatic intraepithelial neoplasia.
  
  
  CONCLUSIONS
  These results indicate that the presence of high grade prostatic intraepithelial neoplasia on needle biopsy is strongly predictive of carcinoma. Prostatic intraepithelial neoplasia should be reported in needle biopsies and biopsy repeated. These finding support the hypothesis that prostatic intraepithelial neoplasia is a precursor of prostate cancer.
authors.affiliation: Nichols Laboratories, Lincoln, Nebraska, USA.
authors.forename: D
authors.initials: D
authors.lastname: Davidson
authors.forename: D G
authors.initials: DG
authors.lastname: Bostwick
authors.forename: J
authors.initials: J
authors.lastname: Qian
authors.forename: P C
authors.initials: PC
authors.lastname: Wollan
authors.forename: J E
authors.initials: JE
authors.lastname: Oesterling
authors.forename: R A
authors.initials: RA
authors.lastname: Rudders
authors.forename: M
authors.initials: M
authors.lastname: Siroky
authors.forename: M
authors.initials: M
authors.lastname: Stilmant
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D004848:Epithelium / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen