Repeat biopsy in patients with initial diagnosis of PIN.
OBJECTIVE
Prostatic intra-epithelial neoplasia (PIN) is considered a pre-malignant lesion and the main precursor of invasive prostatic adenocarcinoma. A PIN diagnosis established by prostate needle biopsy poses a difficult clinical management problem. We retrospectively reviewed our three-year experience in order to identify criteria for referring patients to repeat biopsy.


METHODS
We reviewed the repeat biopsy records of 72 patients in whom PIN had been detected on initial US-guided needle biopsy of the prostate. All the patients had a minimum of 6 biopsy cores taken, and they all had PSA > 4 ng/ml.


RESULTS
Adenocarcinoma was detected in 15 patients out of 50 (30%) with an initial diagnosis of low-grade PIN and in 10 patients out of 22 (45.4%) with high grade PIN, in 7 out of 18 (39%) in whom PSA levels had decreased during the observation interval, in 16 patients out of 46 (35%) in whom the PSA had increased and in 2 patients out of 8 (25%) with stable PSA.


CONCLUSIONS
Our results seem to confirm that PIN can be considered a precursor of prostatic adenocarcinoma or a histological alteration often associated with it. Patients with low-grade PIN and particularly those with high-grade PIN should be regularly subjected to repeat biopsy at short intervals due to the high frequency of the final diagnosis of carcinoma. No agreement has been reached on the time interval between the first and the second biopsy. The PSA changes during the observation period are not a statistically significant parameter to suggest the repetition of prostatic biopsy.
De Matteis
Massimo
M
Dipartimento Area Radiologica, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Bologna. dematteis@orsola-malpighi.med.unibo.it
Poggi
Cristina
C
De Martino
Antonietta
A
Corti
Barbara
B
Barozzi
Libero
L
Pavlica
Pietro
P
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors
D017430:Prostate-Specific Antigen