Prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN): risk of prostatic cancer on repeat biopsies.
OBJECTIVE
To verify prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in 65 patients who underwent repeat biopsies with a mean follow-up of 36 months.


METHODS
In June 2007, after a retrospective revision of the biopsy reports that were performed between January 2002 and December 2006 because of prostate specific antigen (PSA) values greater than 4 ng/mL, but no clinical or ultrasonographic parameters indicative of prostatic cancer (CaP), we selected 65 patients (group 1) (mean age 63.4 years) with initial HGPIN diagnosis and a control group of another 65 patients (group 2) (mean age 64.5 years) with initial diagnosis of benign prostatic tissue (BPT). All the patients underwent rebiopsies 3 to 12, 13 to 24, 25 to 36, and 37 to 48 months after biopsy. After each rebiopsy, 3 diagnoses were made: BPT, HGPIN, and CaP. Prognostic significance of PSA and HGPIN focality at biopsy were also assessed.


RESULTS
Overall, CaP was detected in 14 of 65 (21.5%) group 1 patients and in 15 of 65 (23.0%) group 2 patients. No significant difference was reported between the 2 groups in terms of risk for CaP. Low-medium risk cancer was reported in 12 of 14 (85.7%) cases in group 1 and in 12 of 15 (80.0%) of group 2, mainly after the second rebiopsy. PSA and HGPIN focality at biopsy did not seem to predict CaP diagnosis.


CONCLUSIONS
The risk for cancer after HGPIN diagnosis (21.5%) was not higher than the risk reported after BPT diagnosis (23.0%). PSA and HGPIN focality at biopsy do not enhance cancer predictivity. Patients with a HGPIN diagnosis do not seem to need any different follow-up rebiopsy strategy than patients with a BPT diagnosis.
Gallo
Fabrizio
F
Division of Urology, San Paolo Hospital, Savona, Italy. gallo.fabrizio@fastwebnet.it
Chiono
Luciano
L
Gastaldi
Emilio
E
Venturino
Ezio
E
Giberti
Claudio
C
D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000096:biosynthesis; D019048:Prostatic Intraepithelial Neoplasia / Q000175:diagnosis* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012306:Risk
D017430:Prostate-Specific Antigen