Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?

Lefkowitz, Gary K.; Sidhu, Gurdip S.; Torre, P. de la; Lepor, Herbert; Taneja, Samir S.

doi:10.1016/s0090-4295(01)01436-4

Cited by 89 publications

(36 citation statements)

References 23 publications

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“…The false-negative results on repeated biopsies over time, common to all studies mentioned, are an important issue. Lefkowitz et al (17,18) reported a 25.8% rate of cancer, with an interval to follow-up prostate biopsy of 3 years, studying 31 men with an initial diagnosis of HG-PIN on 12-core biopsy compared with the 2.3% rate of cancer if repeated biopsies were done within 1 year.…”

Section: Discussionmentioning

confidence: 99%

PTOV1 Expression Predicts Prostate Cancer in Men with Isolated High-Grade Prostatic Intraepithelial Neoplasia in Needle Biopsy

Moróte¹,

Fernández²,

Alaña

et al. 2008

Clinical Cancer Research

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Purpose: To analyze the expression of PTOV1 in high-grade prostatic intraepithelial neoplasia (HG-PIN) and to explore its usefulness to predict prostate cancer in patients with isolated HG-PIN in needle biopsy (prostate needle biopsy). Experimental Design: PTOV1expression in HG-PIN lesions from 140 patients was analyzed by immunohistochemistry in a semiquantitative manner (Histo-score). HG-PIN derived from 79 radical prostatectomies for prostate cancer and from 11 cistoprostatectomies for bladder cancer without prostate cancer were used as positive and negative controls, respectively. Fifty patients with HG-PIN without concomitant cancer at their first prostate needle biopsy were chosen as the study group. Patients were followed by a mean of 2.5 repeated prostate needle biopsies (1-5), during a mean period of 12.4 months (1-39). Results: PTOV1expression in HG-PIN from radical prostatectomies showed a significantly higher Histo-score (162.6) compared with specimens from cistoprostatectomies (67.0). In the study group, PTOV1 expression was significantly higher in samples with cancer in the follow-up (11 patients, 22%) compared with samples in which cancer was not detected (151.4 versus 94.6). PTOV1expression was the only independent predictor of cancer in the multivariate analysis and the area under the curve was 0.803 (95% confidence interval, 0.728-0.878). A threshold of 100 for PTOV1 expression provided 90.9% sensitivity, 51.3% specificity, 34.5% positive predictive value, and 95.2% negative predictive value. Conclusions: PTOV1 is overexpressed in HG-PIN associated with cancer and is a potential marker for studying the carcinogenesis and progression of prostate cancer. Prostate needle biopsy with PTOV1 expression in HG-PIN above a threshold of 100 should be repeated immediately for the likely presence of undiagnosed cancer.Prostate tumor overexpressed-1 (PTOV1) was identified in our laboratory as a novel gene and protein during a screening for genes differentially expressed in prostate cancer. PTOV1 protein consists of two repeated blocks of 151 and 147 amino acids, joined by a short linker peptide, and is encoded by a 12-exon gene localized in chromosome 19q13.3 (1). The expression of PTOV1 is regulated by androgens (2). By immunohistochemical analysis, PTOV1 was undetectable in normal prostate tissue and benign prostate hyperplasia, whereas a strong immunoreactivity was shown in areas of carcinoma and high-grade prostatic intraepithelial neoplasia (HG-PIN). The high expression of PTOV1 in tumors correlated with their proliferative status, assessed by Ki67 immunoreactivity, and associated with nuclear localization of the protein, suggesting a functional relationship between PTOV1 overexpression, proliferative status, and nuclear localization. In cultured prostate tumor cells, PTOV1 localized in the cytoplasm of quiescent cells and after serum stimulation, the protein partially translocated to the nucleus. Exogenous overexpression of tagged-PTOV1 induced the entry of cells into the S phase of the cell ...

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Section: Discussionmentioning

confidence: 99%

PTOV1 Expression Predicts Prostate Cancer in Men with Isolated High-Grade Prostatic Intraepithelial Neoplasia in Needle Biopsy

Moróte¹,

Fernández²,

Alaña

et al. 2008

Clinical Cancer Research

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“…Los primeros estudios llevados a cabo en los años 80 y 90 mostraban tasas elevadas de cáncer en la re-biopsia, en torno a un 50% 5,[16][17][18][19][20] . Por el contrario, los trabajos más recientes comunican tasas muy inferiores, entre un 20-25% [21][22][23][24][25] , o incluso inferiores 8 .…”

Section: Discussionunclassified

Significado clínico de la neoplasia intraepitelial prostática y de la proliferación acinar focal atípica: relación con el cáncer de próstata

et al. 2008

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Introducción: El papel de la neoplasia intraepitelial prostática (PIN) y de la proliferación acinar focal atípica (ASAP) en el marco de una biopsia transrrectal todavía no se encuentra por completo definido; aunque ambas lesiones han sido consideradas clási-camente premalignas, hoy en día la necesidad de la rebiopsia sistemática sigue siendo controvertido.Objetivos: En este trabajo hemos estudiado el papel de estas lesiones y su relación con el cáncer de próstata. Material y métodos: Se incluyeron 138 sujetos (108 PIN, 30 ASAP) a los que se le practicó rebiopsia al 67%; la tasa de cán-cer en la rebiopsia inmediata fue del 19 y 27% respectivamente sin identificar ningún factor clínico para predecir cáncer en la rebiopsia (PSA, edad, tacto rectal, volumen prostático).Resultados: Durante el seguimiento, la mayor tasa de cáncer se observó en el ASAP, seguido del PIN y finalmente de las lesiones benignas; el único predictor clínico-patológico independiente de cáncer en este caso fue la existencia de ASAP en la primera biopsia transrrectal.Conclusiones: La necesidad de rebiopsiar sistemáticamente a los sujetos con PIN en la biopsia de próstata ha sido puesta en duda en la literatura reciente, mientras que la necesidad de rebiopsiar los ASAP sigue estando claramente indicado.Palabras claves: Cáncer de próstata. Neoplasia intraepitelial prostática. Proliferación acinar pequeña atípica. Biopsia transrrectal. ABSTRACT CLINICAL SIGNIFICANCE OF PROSTATIC INTRAEPITHELIAL NEOPLASM AND ATYPICAL SMALL ACINAR PROLIFERA-TION: RELATIONSHIP WITH PROSTATE CANCER Introduction: Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain.Objetives: In this paper, we have studied the clinical relevance of these histologic findings. Material and methods: We collected 138 subjects (108 PIN, 30 ASAP); in 67% we performed a second biopsy and the rate of cancer in this late biopsy were 19% and 27% respectively. We cannot identify any clinical factor to predict the finding of cancer in the re-biopsy (PSA, age, digital rectal examination, prostatic volume).Results: In the follow-up, we observed higher rates of cancer for the ASAP; the finding of ASAP was the single clinical or histopathological factor that was an independent predictor of cancer.Conclusions: We observed that the finding of ASAP was an indication for re-biopsy because of the higher rates of cancer; on the contrary, the paper of PIN in the prostatic needle biopsy still requires further investigation.

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“…The mean time of follow-up was 17.3 months (range 1-62). The mean number of biopsy sessions was 2.5 (range 2-6), and the median number of biopsy cores was 10 (range [6][7][8][9][10][11][12][13][14].…”

Section: Methodsmentioning

confidence: 99%

“…1,3,[5][6][7] Conversely, the rate of ASAP on initial biopsy was reported to range from 2.4% to 3.7% 3,8,9 ; the cancer detection rate on repeated biopsy was found to be as high as 52% in isolated ASAP 3,8,10 and 72% in ASAP associated with HGPIN. …”

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confidence: 96%

Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation

Amin

Jeyaganth

Fahmy

et al. 2012

CUAJ

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245The detection rate of HGPIN in TRUSguided needle biopsies performed owing to an elevated PSA level or an abnormal digital rectal examination (DRE), was found to be between 4% and 25% of patients 1-4 and the cancer detection rate on repeated biopsy was reported from 2% to 47% of patients. 1,3,[5][6][7] Conversely, the rate of ASAP on initial biopsy was reported to range from 2.4% to 3.7% 3,8,9 ; the cancer detection rate on repeated biopsy was found to be as high as 52% in isolated ASAP 3,8,10 and 72% in ASAP associated with HGPIN.

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Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?

Cited by 89 publications

References 23 publications

PTOV1 Expression Predicts Prostate Cancer in Men with Isolated High-Grade Prostatic Intraepithelial Neoplasia in Needle Biopsy

PTOV1 Expression Predicts Prostate Cancer in Men with Isolated High-Grade Prostatic Intraepithelial Neoplasia in Needle Biopsy

Significado clínico de la neoplasia intraepitelial prostática y de la proliferación acinar focal atípica: relación con el cáncer de próstata

Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation

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