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The significance of prostatic intra‐epithelial neoplasia
Author(s) -
ABOSEIF S.,
SHINOHARA K.,
WEIDNER N.,
NARAYAN P.,
CARROLL P.R.
Publication year - 1995
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1995.tb07714.x
Subject(s) - medicine , biopsy , transrectal ultrasonography , rectal examination , urology , prostate , prostate biopsy , prostate specific antigen , adenocarcinoma , carcinoma , radiology , cancer
Objective To investigate the relationship between the detection of prostatic intra‐epithelial neoplasia (PIN) on initial prostate biopsy and subsequent invasive prostatic adenocarcinoma. Patients and methods Thirty‐six men (mean age 67 years, range 52–82) with PIN underwent digital rectal examination (DRE), serum prostate‐specific antigen (PSA) measurement and transrectal ultrasonography (TRUS) before the initial biopsy and documentation of PIN. They were followed up with serial PSA, TRUS and a repeat biopsy every 6 months until either invasive carcinoma was identified or 2 years had elapsed. Results The initial biopsy revealed Grade I PIN in 33%, Grade II in 22%, and Grade III in 45% of the men. The repeat biopsy showed evidence of invasive carcinoma in 21 patients (58%; Group I), while 15 (42%) showed persistence of PIN (Group II). In Group I, 19 had had high‐grade PIN (Grade II/III) on initial biopsy compared with one in Group II. The findings on DRE, and age, were not significantly different between groups. TRUS revealed a hypoechoic lesion in 15/21 patients in Group I compared with 7/15 patients in Group II. There was an increase in PSA level in 18 patients in Group I (from 8.4 to 11.6 ng/mL). Conclusions PIN and invasive adenocarcinoma of the prostate were closely associated, and the likelihood for coexistence was higher in patients with high‐grade PIN, increasing PSA level or positive findings on TRUS. We recommend that all patients who show high‐grade PIN on prostate biopsy be followed very closely with serial PSA measurements and repeat biopsies from both the area of PIN and other areas of the prostate.