title: Is high grade prostatic intraepithelial neoplasia still a risk factor for adenocarcinoma in the era of extended biopsy sampling?
abstract: OBJECTIVE
  There is controversy regarding the role of high grade prostatic intraepithelial neoplasia (HGPIN) on prostatic needle biopsy (PNB) as a risk factor for prostatic adenocarcinoma. We utilise a large Canadian database to determine whether HGPIN detected on extended PNB is a significant risk factor for prostatic adenocarcinoma.
  
  
  METHODS
  Pathological findings from PNBs from 12 304 men who underwent initial PNB during an 8 year period were analysed. Patients were included in the study if their initial diagnosis was HGPIN alone or a benign diagnosis, if at least one follow-up PNB was performed, and if both the initial and follow-up PNB contained at least 10 prostate cores.
  
  
  RESULTS
  In the benign group of 105 patients and the HGPIN group of 120 patients, 14.1% and 20.8% were diagnosed with prostatic adenocarcinoma, respectively. When the HGPIN group was further subdivided into unifocal (1 core) and multifocal (>or=2 cores) groups, 9.4% and 29.9% developed prostatic adenocarcinoma, respectively (p < 0.0001). Cox regression analysis adjusting for age and prostate specific antigen (PSA) confirms the significance of HGPIN as a risk factor for prostatic adenocarcinoma (p = 0.0045).
  
  
  CONCLUSIONS
  Patients with an initial diagnosis of multifocal HGPIN on extended PNB are at a greater risk for subsequent prostatic adenocarcinoma than those with unifocal HGPIN or benign diagnoses.
authors.affiliation: Dalhousie University, Halifax, NS, Canada. Jennifer.merrimen@cdha.nshealth.ca
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Merrimen
authors.forename: Glenn
authors.initials: G
authors.lastname: Jones
authors.forename: John R
authors.initials: JR
authors.lastname: Srigley
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001706:Biopsy; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012044:Regression Analysis; D012307:Risk Factors