title: Prostatic intraepithelial neoplasia: influence of clinical and pathological data on the detection of prostate cancer.
abstract: OBJECTIVE
  We attempted to characterize patients diagnosed with prostatic intraepithelial neoplasia without concurrent cancer on biopsy who had prostate cancer on subsequent biopsy.
  
  
  METHODS
  The records of 93 patients with low and high grade prostatic intraepithelial neoplasia without concurrent cancer on initial biopsy were analyzed. The relationships among prostatic intraepithelial neoplasia grades, patient age, digital rectal examination, serum prostate specific antigen (PSA), transrectal ultrasound appearance and final pathological results were investigated.
  
  
  RESULTS
  Subsequent carcinoma was found on repeat biopsy in 13.3% of patients with low grade and 47.9% with high grade prostatic intraepithelial neoplasia (p < 0.001). In the former group digital rectal examination, patient age, serum PSA and transrectal ultrasound were not predictive of cancer. Transrectal ultrasound appearance, digital rectal examination and serum PSA were statistically different between high grade prostatic intraepithelial neoplasia with and without subsequent cancer (p < 0.001, p = 0.008 and p = 0.016, respectively, univariate analysis). On multivariate analysis of patients with high grade prostatic intraepithelial neoplasia only digital rectal examination and PSA were predictive of subsequent carcinoma.
  
  
  CONCLUSIONS
  High grade prostatic intraepithelial neoplasia is a strong predictor of subsequent cancer, especially in men with abnormal digital rectal examination and elevated serum PSA. Patients with high grade prostatic intraepithelial neoplasia should undergo repeat biopsy to exclude cancer. Further investigations are needed to optimize the treatment of patients with low grade prostatic intraepithelial neoplasia.
authors.affiliation: Department or Urology, Erasme Hospital, University Clinics of Brussels, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Raviv
authors.forename: T
authors.initials: T
authors.lastname: Janssen
authors.forename: A R
authors.initials: AR
authors.lastname: Zlotta
authors.forename: F
authors.initials: F
authors.lastname: Descamps
authors.forename: A
authors.initials: A
authors.lastname: Verhest
authors.forename: C C
authors.initials: CC
authors.lastname: Schulman
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies