title: The significance of prostatic intra-epithelial neoplasia.
abstract: OBJECTIVE
  To investigate the relationship between the detection of prostatic intra-epithelial neoplasia (PIN) on initial prostate biopsy and subsequent invasive prostatic adenocarcinoma.
  
  
  METHODS
  Thirty-six men (mean age 67 years, range 52-82) with PIN underwent digital rectal examination (DRE), serum prostate-specific antigen (PSA) measurement and transrectal ultrasonography (TRUS) before the initial biopsy and documentation of PIN. They were followed up with serial PSA, TRUS and a repeat biopsy every 6 months until either invasive carcinoma was identified or 2 years had elapsed.
  
  
  RESULTS
  The initial biopsy revealed Grade I PIN in 33%, Grade II in 22%, and Grade III in 45% of the men. The repeat biopsy showed evidence of invasive carcinoma in 21 patients (58%; Group I), while 15 (42%) showed persistence of PIN (Group II). In Group I, 19 had had high-grade PIN (Grade II/III) on initial biopsy compared with one in Group II. The findings on DRE, and age, were no significantly different between groups. TRUS revealed a hypoechoic lesion in 15/21 patients in Group I compared with 7/15 patients in Group II. There was an increase in PSA level in 18 patients in Group I (from 8.4 to 11.6 ng/mL).
  
  
  CONCLUSIONS
  PIN and invasive adenocarcinoma of the prostate were closely associated, and the likelihood for coexistence was higher in patients with high-grade PIN, increasing PSA level or positive findings on TRUS. We recommend that all patients who show high-grade PIN on prostate biopsy be followed very closely with serial PSA measurements and repeat biopsies from both the area of PIN and other areas of the prostate.
authors.affiliation: Department of Urology, University of California School of Medicine, San Francisco, USA.
authors.forename: S
authors.initials: S
authors.lastname: Aboseif
authors.forename: K
authors.initials: K
authors.lastname: Shinohara
authors.forename: N
authors.initials: N
authors.lastname: Weidner
authors.forename: P
authors.initials: P
authors.lastname: Narayan
authors.forename: P R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen