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Widespread high grade prostatic intraepithelial neoplasia on biopsy predicts the risk of prostate cancer: A 12 months analysis after three consecutive prostate biopsies

Cosimo De Nunzio, Simone Albisinni, Antonio Cicione, Mauro Gacci, Costantino Leonardo, Francesco Esperto, Andrea Tubaro
  • Cosimo De Nunzio
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy | cosimodenunzio@virgilio.it
  • Simone Albisinni
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy
  • Antonio Cicione
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy
  • Mauro Gacci
    Department of Urology, Ospedale Careggi, University of Florence, Italy
  • Costantino Leonardo
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy
  • Francesco Esperto
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy
  • Andrea Tubaro
    Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy

Abstract

Purpose: To evaluate the risk of prostate cancer (PCa) on a third prostate biopsy in a group of patients with two consecutive diagnoses of high grade intraepithelial neoplasia (HGPIN). Materials and methods: From November 2004 to December 2007, patients referred to our clinic with a PSA ! 4 ng/ml or an abnormal digital rectal examination (DRE) were scheduled for trans-rectal ultrasound (TRUS) guided 12-core prostate biopsy. Patients with HGPIN underwent a second prostate biopsy, and if the results of such procedure yielded a second diagnosis of HGPIN, we proposed a third 12-core needle biopsy regardless of PSA value. Crude and adjusted logistic regressions were used to assess predictors of PCa on the third biopsy. Results: A total of 650 patients underwent 12 cores transrectal ultrasound prostatic biopsy in the study period. Of 147 (22%) men with a diagnosis of HGPIN, 117 underwent a second prostatic biopsy after six months and 43 a third biopsy after other six months. After the third biopsy, 19 patients (34%) still showed HGPIN, 15 (35%) were diagnosed with PCa and 9 (21%) presented with chronic prostatitis. Widespread HGPIN on a second biopsy was significantly associated with PCa on further biopsy (!2 = 4.04, p = 0.04). Moreover, the presence of widespread HGPIN significantly predicted the risk of PCa on crude and adjusted logistic regressions. Conclusions: Widespread HGPIN on second biopsy is associated with the presence of PCa on a third biopsy. Nonetheless, the relationship between HGPIN and PCa remains complex and further studies are needed to confirm our findings.

Keywords

Prostate cancer; High grade prostatic intraepithelial neoplasia; Biopsy; Gleason score; Widespread

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Submitted: 2013-06-24 16:22:39
Published: 2013-06-24 00:00:00
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Copyright (c) 2013 Cosimo De Nunzio, Simone Albisinni, Antonio Cicione, Mauro Gacci, Costantino Leonardo, Francesco Esperto, Andrea Tubaro

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