Should high-grade prostatic intraepithelial neoplasia change our approach to infravesical obstruction?
OBJECTIVE
To investigate whether coexistence of high-grade prostatic intraepithelial neoplasia (HPIN) should change our therapeutic approach to infravesical obstruction.


METHODS
Of 505 patients who underwent sextant transrectal ultrasonography (TRUS)-guided prostate biopsy, 65 (12.8%) had HPIN and 29 of them underwent prostatectomy (23 transurethral resection of prostate (TURP), 6 open) due to obstructive urinary symptoms. Patients without carcinoma were followed up with semiannual prostate-specific antigen (PSA) and digital rectal examination. After a follow-up of 24.8 +/- 11.0 months, 19 of 29 patients who accepted our call had another sextant biopsy.


RESULTS
Mean age and initial mean PSA values of 29 patients were 67.6 +/- 6.7 years and 9.26 +/- 5.91 ng/ml, respectively. The final pathological evaluation of the surgical specimens revealed 2 prostatic adenocarcinomas both in the TURP group. The remaining 27 (93.2%) patients were found to have benign prostatic hyperplasia (BPH) and their serum PSA levels declined from 9.26 +/- 5.91 to 4.59 +/- 2.0 ng/ml 3 months after prostatectomy. Of the 19 patients who had another biopsy with a mean PSA value of 4.06 +/- 4.61 ng/ml, 15 and 4 of them had BPH and HPIN respectively.


CONCLUSIONS
Our preliminary data indicate that the presence of HPIN on TRUS-guided biopsies is not a factor to delay an indicated surgical intervention for infravesical obstruction.
Tunc
Murat
M
Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
Sanli
Oner
O
Kandirali
Engin
E
Tefekli
Ahmet
A
Oktar
Tayfun
T
Esen
Tarik
T
Acar
Omer
O
Uysal
Veli
V
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery; D019048:Prostatic Intraepithelial Neoplasia / Q000150:complications / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery*