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Is high grade prostatic intraepithelial neoplasia still a risk factor for adenocarcinoma in the era of extended
Jennifer L Merrimen1, Glenn Jones, John R Srigley
1Dalhousie University, Halifax, NS, Canada. Jennifer.merrimen@cdha.nshealth.ca
Aims:
There is controversy regarding the role of high grade prostatic intraepithelial neoplasia (HGPIN) on prostatic needle biopsy (PNB) as a risk factor for prostatic adenocarcinoma. We utilise a large Canadian database to determine whether HGPIN detected on extended PNB is a significant risk factor for prostatic adenocarcinoma.
Methods:
Pathological findings from PNBs from 12 304 men who underwent initial PNB during an 8 year period were analysed. Patients were included in the study if their initial diagnosis was HGPIN alone or a benign diagnosis, if at least one follow-up PNB was performed, and if both the initial and follow-up PNB contained at least 10 prostate cores.
Results:
In the benign group of 105 patients and the HGPIN group of 120 patients, 14.1% and 20.8% were diagnosed with prostatic adenocarcinoma, respectively. When the HGPIN group was further subdivided into unifocal (1 core) and multifocal (>or=2 cores) groups, 9.4% and 29.9% developed prostatic adenocarcinoma, respectively (p < 0.0001). Cox regression analysis adjusting for age and prostate specific antigen (PSA) confirms the significance of HGPIN as a risk factor for prostatic adenocarcinoma (p = 0.0045).
Conclusions:
Patients with an initial diagnosis of multifocal HGPIN on extended PNB are at a greater risk for subsequent prostatic adenocarcinoma than those with unifocal HGPIN or benign diagnoses.
