title: Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era.
abstract: OBJECTIVE
  High grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) in the sextant biopsy had been associated with a high risk of prostate cancer. We determined whether the extended biopsy schemes used in the contemporary era have altered the prognostic value of these lesions at repeat biopsies.
  
  
  METHODS
  From 1998 to 2003, 105 of 1,188 men had at least 1 repeat extended biopsy due to the presence of HGPIN (33 men) or ASAP (72 men) in a previous extended biopsy. Median biopsy interval for HGPIN and ASAP was 15 and 10 weeks (p <0.05), respectively. Differences in cancer detection rates were analyzed using the Pearson chi-square test.
  
  
  RESULTS
  In the HGPIN group only 1 of 22 (4.5%) men had cancer on 1st repeat biopsy and 0 of 11 men had cancer on 2nd repeat biopsy. In men with ASAP 19 of 53 (36%, p <0.005) had cancer on 1st repeat biopsy, and 3 of 19 (16%) had cancer on 2nd repeat biopsy. Cancer was confined to a single core in 16 of 22 (73%) men. Median Gleason score was 6. Patient age, digital rectal examination status, prostate specific antigen, free prostate specific antigen, number of cores and biopsy interval were not independent predictors of cancer in men with ASAP.
  
  
  CONCLUSIONS
  HGPIN found in the contemporary extended biopsy does not warrant repeat biopsy. ASAP continues to be associated with a high risk of cancer and requires at least 1 repeat biopsy using the extended biopsy scheme.
authors.affiliation: Division of Urology, Albany Medical College and Stratton Veterans Administration Medical Center, Albany, NY 12208, USA.
authors.forename: Courtenay K
authors.initials: CK
authors.lastname: Moore
authors.forename: Shridevi
authors.initials: S
authors.lastname: Karikehalli
authors.forename: Tipu
authors.initials: T
authors.lastname: Nazeer
authors.forename: Hugh A G
authors.initials: HA
authors.lastname: Fisher
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Kaufman
authors.forename: Badar M
authors.initials: BM
authors.lastname: Mian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen