What is the clinical significance of isolated high-grade prostatic intraepithelial neoplasia discovered on a prostate needle core biopsy? How often does it occur? Does its presence predict cancer on a subsequent biopsy? Are there any specific clinical or pathologic findings that favorably predict cancer on a subsequent biopsy?
The incidence of high-grade intraepithelial neoplasia (HGPIN) depends on the study population and the number of biopsy cores examined. Among men screened for prostate cancer by the serum prostate-specific antigen (PSA) assay, the frequency of isolated HGPIN (without concomitant cancer) is 4%–10%. Traditionally, HGPIN has a high predictive value as a marker for adenocarcinoma. A repeat biopsy is generally indicated in men with HGPIN. It should not be limited to the HGPIN loci. The clinical parameters—including the initial PSA, changes in PSA, and digital rectal examination (DRE) and transrectal ultrasonography (TRUS) findings—do not appear useful. However, the number of biopsy cores involved by HGPIN is predictive. If cancer is not found on the next two follow-up biopsies, it is unlikely that cancer will be found on a subsequent biopsy. With wide application of the extended prostate needle core biopsy, the predictive value of HGPIN is decreasing as many cancers have been detected on the initial biopsy.
KeywordsProstate Biopsy Digital Rectal Examination Repeat Biopsy Prostatic Intraepithelial Neoplasia Initial Biopsy
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