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[Prostatic intraepithelial neoplasm diagnosed with transrectal biopsy. Overall review]
1Servicio de Urología, H.G.U., Gregorio Marañón, Madrid.
Objective:
To review the incidence, clinical features and management guidelines for patients with isolated prostatic intraepithelial neoplasia (PIN) diagnosed through prostate transrectal biopsy.
Methods And Results:
Search in Medline database for papers published between 1990 and 2000 based on the following key words: "prostatic intraepithelial neoplasia and needle biopsy". Nineteen papers fulfilling the search criteria were selected.
Conclusions:
The incidence of PIN in patients seen as part of an early diagnosis program is much lower than in patients attending standard Urology practices. PSA level and ultrasound changes are poor predictors of PIN presence in the biopsy. Prostate cancer incidence in successive biopsies ranges between 13.3% and 100%. None of the clinical variables used to diagnose prostate cancer (DRE, PSA and transrectal ultrasound) can predict accurately the existence of cancer associated to PIN, and only prostatic intraepithelial neoplasia grading is considered a good cancer predictor. There is no consensus with regard to diagnostic and therapeutic management in these patients.