Effect of Neoadjuvant Hormonal Therapy on Prostatic Intraepithelial Neoplasia and Its Prognostic Significance

Balaji, K.C.; Rabbani, Farhang; Tsai, Harold; Bastar, Andrew; Fair, William R.

doi:10.1097/00005392-199909010-00035

Cited by 40 publications

(21 citation statements)

References 14 publications

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“…Prostatic intraepithelial neoplasia was not predictive of PSA (biochemical) failure at 32 months in patients undergoing radical prostatectomy and androgen deprivation therapy [45].…”

Section: Does Prostatic Intraepithelial Neoplasia Predict Cancer Recumentioning

confidence: 90%

“…There is a marked decrease in the prevalence and extent of high-grade PIN in cases after androgen deprivation therapy when compared with untreated cases [45,46]. This decrease is accompanied by epithelial hyperplasia, cytoplasmic clearing, and prominent glandular atrophy, with decreased ratio of glands to stroma.…”

Section: Can Androgen Deprivation Therapy Eliminate Prostatic Intraepmentioning

confidence: 97%

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Prostatic intraepithelial neoplasia

Bostwick

2000

Curr Urol Rep

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High-grade prostatic intraepithelial neoplasia (PIN) is now accepted as the most likely pre-invasive stage of adenocarcinoma, a decade after its first formal description. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeat biopsy for concurrent or subsequent invasive carcinoma. The only method of detection is biopsy; PIN does not significantly elevate serum prostate-specific antigen concentration or its derivatives and cannot be detected by ultrasound. Most studies suggest that most patients with PIN will develop carcinoma within 10 years. PIN is associated with progressive abnormalities of phenotype and genotype that are similar to cancer rather than normal prostatic epithelium, indicating impairment of cell differentiation with advancing stages of prostatic carcinogenesis. Androgen deprivation therapy decreases the prevalence and extent of PIN, suggesting that this form of treatment may play a role in chemoprevention.

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“…Prostatic intraepithelial neoplasia was not predictive of PSA (biochemical) failure at 32 months in patients undergoing radical prostatectomy and androgen deprivation therapy [45].…”

Section: Does Prostatic Intraepithelial Neoplasia Predict Cancer Recumentioning

confidence: 90%

Section: Can Androgen Deprivation Therapy Eliminate Prostatic Intraepmentioning

confidence: 97%

Prostatic intraepithelial neoplasia

Bostwick

2000

Curr Urol Rep

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“…However, as we mentioned before, Qian et al [22] showed that HGPIN was more extensive in small cancers than in larger cancers. In their prospective trial, Balaji et al [26] reported that the presence of HGPIN on an RP specimen was not predictive of biological relapse based on a subanalysis of 275 patients. In a more recent publication, Al-Hussain and Epstein [27] suggested that patients previously diagnosed with HGPIN on needle biopsies and treated by RP for prostate cancer would have better outcomes than if they had cancer diagnosed de novo.…”

Section: Discussionmentioning

confidence: 99%

Concomitant High-Grade Prostatic Intraepithelial Neoplasia Is Associated with Good Prognosis Factors and Oncologic Outcome after Radical Prostatectomy

Ingels

Ploussard²,

Allory³

et al. 2013

Urol Int

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Objectives: To assess correlations between concomitant high-grade prostatic intraepithelial neoplasia (HGPIN), pathological features and oncologic outcomes after radical prostatectomy (RP). Material and Methods: We prospectively collected a single-institution database of 2,351 patients who underwent RP between 1998 and 2011. Results: 1,272 (54.1%) patients had HGPIN on specimens. The mean follow-up was 28 months. Presence of HGPIN was significantly associated with a favorable preoperative risk status and with pathological factors of poor prognosis in RP specimens. Patients without HGPIN had a worse biochemical recurrence-free survival compared with those with HGPIN in RP specimen (log-rank test: p = 0.015). The 3-year RFS rate was 73.9% for the HGPIN group versus 67.2%. The absence of HGPIN was also significantly correlated with the use of androgen deprivation treatment during the follow-up (p < 0.001). In Cox multivariate analysis, taking into account the other prognostic pathological factors, HGPIN was not an independent predictive factor for PSA failure (p = 0.868). Conclusion: HGPIN is associated with factors of good prognosis but fails to show independent significance when classical pathological prognostic factors are taken into account.

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“…The development and identification of acceptable agents to treat high grade PIN would fill a greatly needed therapeutic void [38]. There is evidence that all modes of androgen deprivation that induce acinar atrophy and apoptosis cause regression of high grade PIN [39][40][41][42]. Neoadjuvant hormone deprivation with monthly leuprolide and flutamide, 250 mg orally twice a day for 3 months, resulted in a 50% reduction in high grade PIN [40].…”

Section: Prostatic Intraepithelial Neoplasia Is a Diseasementioning

confidence: 99%

“…There is evidence that all modes of androgen deprivation that induce acinar atrophy and apoptosis cause regression of high grade PIN [39][40][41][42]. Neoadjuvant hormone deprivation with monthly leuprolide and flutamide, 250 mg orally twice a day for 3 months, resulted in a 50% reduction in high grade PIN [40]. Longer therapy with 6 months of neoadjuvant androgen deprivation therapy prior to radical prostatectomy in the European Randomized Study of Screening for Prostate Cancer (ERSPC) study reduced high grade PIN even more [43].…”

Section: Prostatic Intraepithelial Neoplasia Is a Diseasementioning

confidence: 99%

High grade prostatic intraepithelial neoplasia is a disease

Steiner

2001

Curr Urol Rep

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High grade prostatic intraepithelial neoplasia (PIN) is now widely accepted as the main premalignant lesion that has the potential to progress to prostate adenocarcinoma. High grade PIN is a standard diagnosis that must be included as part of the reported pathologic evaluation of prostate biopsies. Premalignant lesions that affect other organs have been identified and are treated when diagnosed such that the premalignant lesions itself are a disease (eg, carcinoma in situ of the bladder, colon polyps, and cervical dysplasia). Urologists should recognize that high grade PIN is a dangerous lesion and that it should be aggressively managed either by saturation biopsies of the prostate following the diagnosis of high grade PIN, or the more common recommendation--repeated prostate biopsies every 3 to 6 months for 2 years, then annually. Treatment of these precancerous lesions would appear to be of clinical benefit notwithstanding the potential for cancer prevention. These clinical benefits would reduce morbidity, enhance the quality of life, delay surgery or radiation, and increase the interval for surveillance requiring invasive procedures.

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Effect of Neoadjuvant Hormonal Therapy on Prostatic Intraepithelial Neoplasia and Its Prognostic Significance

Abstract: While patients treated with neoadjuvant hormonal therapy had significantly lower incidence of prostatic intraepithelial neoplasia, neither prostatic intraepithelial neoplasia nor neoadjuvant hormonal therapy significantly affected PSA recurrence at a median followup of 32 months.

Cited by 40 publications

References 14 publications

Prostatic intraepithelial neoplasia

Prostatic intraepithelial neoplasia

Concomitant High-Grade Prostatic Intraepithelial Neoplasia Is Associated with Good Prognosis Factors and Oncologic Outcome after Radical Prostatectomy

High grade prostatic intraepithelial neoplasia is a disease

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