Adult urology: CMEMonofocal and plurifocal high-grade prostatic intraepithelial neoplasia on extended prostate biopsies: factors predicting cancer detection on extended repeat biopsy
Section snippets
Material and methods
From January 1995 to June 2002, 2314 patients underwent a 10 to 12-core systematic TRUS-guided biopsy. At least five biopsy cores were taken in each lobe; in addition to sextant biopsy cores, cores were taken from both the far lateral region of the gland and the transition zone, depending on the gland volume (10 cores for prostate size less than 50 g and 12 cores for prostate size of 50 g or more; Fig. 1). One to two additional biopsy cores were taken from any hypoechoic area visualized at
Results
The patient characteristics are reported in Table I. CaP was detected on the second biopsy in 21 (44.6%) of the 47 patients with isolated HGPIN at the first histologic examination. HGPIN was confirmed in 20 patients (42.5%), and benign tissue was diagnosed in 6 (12.9%). CaP was detected in a different site compared with the HGPIN site at first biopsy in 5 patients (24%). In 2 patients, positive findings were obtained from the same lobe and in 3 cases, from the contralateral lobe (14%). Of the
Comment
The clinical importance of HGPIN is its high predictive value as a marker for carcinoma. Many studies have reported a CaP yield on repeated biopsy owing to a previous HGPIN diagnosis ranging from 22% to 100%.12, 13, 14, 15, 16, 17, 18 Several investigators have analyzed the prognostic value of PSA, PSAD, patient age, prostate volume, and abnormal DRE and/or TRUS findings in patients with an initial HGPIN diagnosis. However, no consensus has yet been reached regarding when and how to repeat
Conclusions
Patients with an initial, isolated monofocal or plurifocal HGPIN diagnosis after 10 to 12 systematic biopsy cores plus additional directed biopsy cores to hypoechoic areas have a high risk of having CaP detected on a subsequent extended biopsy (45%). In a significant percentage of cases, the CaP location did not correlate with the HGPIN site. Thus, a repeat biopsy that is ipsilateral to the HGPIN site could miss approximately 15% of CaP cases. We, therefore, suggest performing extended,
References (28)
- et al.
Intraductal dysplasiaa premalignant lesion of the prostate
Hum Pathol
(1986) - et al.
Frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients
J Urol
(1993) - et al.
Cytological atypia in the prostate glandfrequency, distribution and possible relevance to carcinoma
J Urol
(1986) - et al.
Prostatic intraepithelial neoplasia is a risk factor for adenocarcinomapredictive accuracy in needle biopsies
J Urol
(1995) - et al.
The incidence of high grade prostatic intraepithelial neoplasia in needle biopsies
J Urol
(1995) - et al.
Strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia detected by prostate needle biopsy
J Urol
(1996) - et al.
Strategy for repeat biopsy in patients with high grade prostatic intraepithelial neoplasia
J Urol
(2000) - et al.
Predictors of first repeat biopsy cancer detection with suspected local stage prostate cancer
J Urol
(2000) - et al.
Risk of concurrent prostate cancer in cystoprostatectomy specimens is related to volume of high-grade prostatic intraepithelial neoplasia
Urology
(1997) - et al.
Follow-up of atypical prostate needle biopsies suspicious for cancer
Urology
(1999)
Significance of high-grade prostatic intraepithelial neoplasia in needle biopsy specimens
Urology
Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy
J Urol
Is repeat biopsy for high grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?
Urology
Detection of high grade prostatic intraepithelial neoplasia with the five region biopsy technique
Urology
Cited by (56)
Neoplasms of the Prostate
2020, Urologic Surgical PathologyAtypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review
2017, UrologyCitation Excerpt :Consequently, rebiopsy after 1 year remains a controversial topic. This is highlighted well by Roscigno et al who found that if rebiopsy was performed within 6 months of initial diagnosis of HGPIN, there was, as expected, a PCa detection rate of 25%.15 However, if rebiopsy was delayed and performed within 11.4 months, there was a significantly higher detection rate of 44.6%.
The Pathology of Prostate Cancer
2010, Early Diagnosis and Treatment of Cancer Series: Prostate Cancer