title: Patients with metabolic syndrome and widespread high grade prostatic intraepithelial neoplasia are at a higher risk factor of prostate cancer on re-biopsy: a prospective single cohort study.
abstract: OBJECTIVE
  To test the hypothesis that patients with widespread high grade prostatic intra epithelial neoplasia (wHGPIN) and metabolic syndrome (MetS) are at a higher risk of prostate cancer (PCa) at a repeat biopsy.
  
  
  METHODS
  We prospectively evaluated 161 patients submitted from December 2004 to December 2011 to prostate rebiopsy after a initial diagnosis of HGPIN in a tertiary academic center. A 12 core biopsy template was used for all the biopsies. Rebiopsy was performed six months after the initial biopsy independently from PSA level and the DRE finding. wHGPIN was defined as≥4 biopsy cores involved. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III criteria.
  
  
  RESULTS
  Overall, 64 patients (39.7%) presented wHGPIN and 97 isolated HGPIN (60.3%). MetS was found in 63 patients, 39.1% of the whole population. Out of them 16 (25.3%) and 47 (74.7%) patients had a diagnosis of isolated and wHGPIN (P = 0.001). PCa detection rate at repeat biopsy was significantly higher in patients with MetS and wHGPIN than in those with wHGPIN and no MetS (57.4% Vs 23.5%; P = 0.016). A logistic regression model confirmed that wHGPIN and MetS are independent risk factors of prostate cancer diagnosis (respectively: Odds ratio (OR) = 4.187, 95%CI: 1.65-10.57 p = 0.002 and OR=3.603, 95%CI: 1.41-9.19, p = 0.007).
  
  
  CONCLUSIONS
  Patients with MetS and wHGPIN are at a higher risk of PCa, therefore performing a new prostate biopsy in those patients should be recommended.
authors.affiliation: Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. Electronic address: acicione@libero.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cantiello
authors.affiliation: La Sapienza University, Department of Urology, Sant' Andrea Hospital, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: La Sapienza University, Department of Urology, Sant' Andrea Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.affiliation: Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D007249:Inflammation; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000150:complications* / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000150:complications* / Q000175:diagnosis*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen