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High grade PIN and ASAP do not predict the diagnosis of prostate cancer in a modern cohort of patients.
Michael P. Herman, Michael J. Schwartz, Andrew Hung, David Hwang, Jullet Han, Ming-Ming Lee, Justin W. McClain, M. Mendel Shemtov, Alexis E. Te, R. Ernest Sosa, E. Darracott Vaughan, Jr., Douglas S. Scherr
Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University
Introduction and objective: There is conflicting data regarding whether or not prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP) are premalignant lesions that warrant closer surveillance to detect prostate cancer. We examined a large cohort of patients with multiple biopsies performed at a single institution during the PSA era to determine if these findings predict the diagnosis of prostate cancer on subsequent biopsy.
Methods: A database of all transrectal ultrasound (TRUS) guided prostate biopsies performed from August 1993 through December 2005 was compiled from a retrospective chart review. Patient age, PSA, digital rectal exam (DRE) findings, indication for biopsy, and biopsy results were recorded. We examined those patients with pathological results from multiple biopsies to determine if PIN or ASAP correlated with finding prostate cancer on a subsequent biopsy. A total of 2735 patients met inclusion criteria. PIN was further divided into high grade PIN (HGPIN) to determine if these lesions were more predictive of prostate cancer. Patients who did not have complete pathological information from prior biopsies were excluded. Statistics were performed using a chi-square analysis.
Results: Twenty-eight out of one hundred fifty-one patients with PIN (18.5%) and twenty out of ninety-five patients with HGPIN (21.1%) had prostate cancer on a subsequent biopsy. This was significantly lower than the rate of prostate cancer in men without these findings (p=0.0002 and p=0.02). It is unclear why PIN and HGPIN showed a statistically lower risk of prostate cancer diagnosis, but it is likely due to the relatively small number of patients with these findings. Men with ASAP had a 34.3% chance of being diagnosed with cancer on a later biopsy, compared to 34.1% of men with no prior abnormal findings (p=0.78).
Conclusions: The finding of ASAP or PIN, either low or high grade, on prostate biopsy does not increase the risk of prostate cancer diagnosis on subsequent biopsies in a large, modern cohort of patients. Therefore, these patients do not need more aggressive surveillance compared to patients without abnormal findings on initial prostate biopsy.