Predicting prostate cancer at rebiopsies in patients with high-grade prostatic intraepithelial neoplasia: a study on 546 patients

Abstract

The aim of this study was to analyse the factors that predict the diagnosis of prostate cancer (PCa) after high-grade prostatic intraepithelial neoplasia (HGPIN). Data from 546 patients with HGPIN submitted up to a 6-month series of three rebiopsies, according to an institutional protocol, were reviewed. PCa has been found in 174 cases (31.8%), in 116 cases at the first and in 58 cases at a further rebiopsy. The risk of finding PCa at the first rebiopsy was correlated with the PSA value and with an anomalous digital rectal examination (DRE) at the time of the initial biopsy; the risk at a subsequent rebiopsy was correlated to the number of cores with HGPIN, with a cutoff of four, and to the ratio with the total number of cores ('PIN density'), with a cutoff of 50%, at the time of initial biopsy. A tailored protocol of controls can be suggested: (a) higher PSA value and/or anomalous DRE: early extended or saturation rebiopsy; (b) number of cores with HGPIN X4 and/or PIN density X50%: delayed rebiopsy; and (c) no risk factors: PSA and DRE controls.

Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume

“… 9 , 10 , 23 Based on these facts, two or more cores of HGPIN on a TRUS-guided biopsy with 10 or 12 cores strongly indicate the presence of PCa. Furthermore, the detection rate (88.9%) of PCa at repeat biopsy in patients who had two or more cores of HGPIN at a previous TRUS-guided biopsy is higher than those of other reports (30.9%, 20 31.8%, 21 and 40% 10 ). The high detection rate of PCa in the present study can be explained as follows.…”

Expression of ERG protein, a prostate cancer specific marker, in high grade prostatic intraepithelial neoplasia (HGPIN): lack of utility to stratify cancer risks associated with HGPIN

“…Many studies have found that clinical parameters, including a patient's age, various forms of serum PSA measurement and abnormal DRE, do not correlate with the cancer risk associated with HGPIN in subsequent biopsy [5,36]. In the present study, we did not find that a patient's age and the number of repeat biopsy sessions were associated with different cancer risk.…”

“…The overall PCa detection rate at repeat biopsy in this series was 38.3%, higher than the 20%–32% in other published reports [3–5]. The difference is probably due to the longer follow‐up in our series.…”

High-Grade Prostatic Intraepithelial Neoplasia

“…The estimated time frame to disease progression after HGPIN findings has been reported to be between 29 and 36 months [5,6]. In addition, an increase in the size and number of HGPIN foci has been associated with both prostate adenocarcinoma and its multifocality [7-13]. HGPIN and carcinoma tend to preferentially involve the peripheral zone of the prostate [8,9], and recently many biomarkers and molecular changes such as TMPRSS2-ERG gene fusion have been described in both entities (as discussed further below) [14,15].…”

“…This decrease in the incidence of cancer following a diagnosis of HGPIN is likely related to the increase in the number of needle core biopsies taken, which has improved the accuracy of the initial biopsy. As one would expect with a pre-malignant lesion, the rate of cancer detection on repeat biopsy has been strongly correlated with an increasing number of cores (≥2) containing HGPIN in the initial biopsy [7,12,13]. As a result, this has led to the recommendation of repeat prostate biopsy within 1 year of such findings.…”