High-Grade Prostatic Intraepithelial Neoplasia and Atypical Small Acinar Proliferation

Abstract

In earlier studies, prostate cancer (PCa) has been reported to appear in 21% to 48% of subsequent biopsies for isolated high-grade prostatic intraepithelial neoplasia (PIN) and in 34% to 60% for isolated atypical small acinar proliferation suspicious for, but not diagnostic of, malignancy (ASAP). We report results of follow-up biopsies in a recent cohort of community practice patients who underwent biopsy for PSA abnormalities. The study group consisted of 336 men with initial diagnoses of PIN (n = 204), ASAP (n = 78), or both lesions (n = 54) who underwent at least one repeat biopsy. Mean follow-up intervals in months were 6.0 for PIN, 3.8 for ASAP, and 4.9 for PIN/ASAP. Follow-up PCa detection rates were 23%, 37%, and 33%, respectively. The predictive value of ASAP was significantly higher than that for PIN (P = 0.0188). In 23 PIN studies with chronologic midpoints in the early 1990s, follow-up PCa was detected in a mean of 36% of cases, whereas this value was 21% after the year 2000. In 13 ASAP studies, mean PCa detection on follow-up was 45% until 1996 and 39% from 1997 to present. PIN/ASAP predicted PCa in 33% of cases in our study, similar to ASAP alone (P = 0.65) and had a mean predictive value of 44% in the literature. Factors that may account for the decline in PIN predictive values include: 1) extended biopsy techniques that yield higher rates of initial cancer detection, 2) lower detection rate for the remaining small cancers that may accompany PIN, and 3) remaining PIN cases may lack concomitant cancer.

ERG Rearrangement for Predicting Subsequent Cancer Diagnosis in High-Grade Prostatic Intraepithelial Neoplasia and Lymph Node Metastasis

“…While HGPIN is pathogenically associated with prostate cancer, there is a greater disparity in the incidence of prostate cancer after diagnosis of HGPIN, ranging from uninterpretable 2% to 100% (23)(24)(25). Although ERG rearrangement is highly specific for prostate cancer, it is also found in a subset of HGPIN glands that are intermingled with fusion-positive cancer glands (11,13).…”

The incidence of prostate carcinoma on repeated biopsy detected after an initial diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation

“…Odsustvo dostupnosti imunohistohemijskih bojenja, koje mogu diferentovati benigne od malignih acinusa, i slab dijagnostički značaj odsustva bazalnih ćelija u nekim slučajevima komplikuje dijagnozu AP. 12,13,14 Takođe, ASAP je stanje u kome patolog ima nedovoljno podataka da napravi dijagnozu, i raste sumnja na karcinom. Mnoge studije su pokušale da identifikuju kliničke, histološke ili molekularne karakteristike ASAP koje koreliraju sa rizikom od AP u ponovnim pratećim biopsijama, ali do sada nema pokazanih prediktivnih parametara.…”

“…Odsustvo dostupnosti imunohistohemijskih bojenja, koje bi mogle uvek diferentovati benigne od malignih acinusa, i slab dijagnostički značaj odsustva bazalnih ćelija u nekim slučajevima komplikuje dijagnozu AP. 12,13,14 Tabela 3. Broj i procenat dijagnostikovanog Adenokarcinoma prostate u ponovnim biopsijama prostate kod 45 slučajeva Visoko stepenog PIN, 7 slučajeva ASAP i 3 slučaja VSPIN/ASAP dijagnostikovanih na inicijalnoj biopsiji u odnosu na broj uzoraka zahvaćenih VSPIN/ASAP u iglenim biopsijama prostate TRUS-vođena biopsija prostate, koja je dostupna i lako izvodljiva metoda, je prihvaćena kao zlatni standard u dijagnozi AP.…”

“…Prema nekim podacima iz literature po-PONS Medicinski časopis / PONS Medical Journal STRUČNI RAD / PROFESSIONAL ARTICLE kazana je korelacija između broja uzetih isečaka prostate koji su zahvaćeni VSPIN i ASAP na incijalnoj biopsiji sa dijagnostikovanim AP na ponovljenim biopsijama. 9,12,19 Naši rezultati su komparabilni sa podacima iz literature. Naime, u odnosu na broj uzetih isečaka VSPIN i/ili ASAP su nađene u prvoj grupi u 29,1% sl, u drugoj grupi u 38,2% i trećoj grupi u 44,6%.…”

High grade intraepithelial neoplasia of prostate is associated with values of prostate specific antigen related parameters intermediate between prostate cancer and normal levels

“…HGPIN in prostate biopsy is a risk factor for detection of prostate carcinoma in subsequent biopsies with the incidence ranges from 21% to 73% [4,5,6,7]. Atypical small acinar proliferation (ASAP) adjacent to HGPIN seems to confer an even higher risk for subsequent cancer detection of 53% [8,9,10]. HGPIN seems to be more often associated with the characteristics of the poor prognosis for relapse of prostate cancer [11].…”