THE "NEW" PROSTATE CANCER INFOLINK

With the increasing use of initial 12-core biopsy templates, there is a question about the interpretation of the amount of high-grade prostatic intraepithelial neoplasia (HGPIN) found on initial biopsy and risk for prostate cancer.

De Nunzio et al. have reported on data collected from 650 patients evaluated at their clinic between December 2004 to September 2007. All patients had been referred to the clinic with a PSA value of ≥ 4 ng/ml or an abnormal digital rectal examination and were scheduled for transrectal ultrasound-guided prostatic biopsy using a 12-core template. In patients initially diagnosed with HGPIN, the authors proposed a second PSA evaluation and a new 12-core biopsy after 6 months, regardless of the PSA level.

The results of their study were as follows:

• 147/650 patients (22 percent) had HGPIN on their initial biopsy.
• 117 of these patients underwent a second biopsy 6 months later.
• Patient characteristics (age, total PSA level, free:total PSA ratio, prostate volume, and PSA density) were all similar at initial and repeat biopsy.
• On second biopsy, 22/117 patients (18.8 patients) were diagnosed with prostate cancer (14 with Gleason score 6, 7 with Gleason score 7, and 1 with a Gleason score 8) and 75/117 (64.2 percent) again showed isolated HGPIN and 20 (17 percent) had chronic prostatitis.
• The number of cores (4 or more) involved with HGPIN on the first biopsy was significantly associated with prostate cancer on the second biopsy (p = 0.001).
• PSA levels could not be used to distinguish risk for prostate cancer from risk for benign disease or HGPIN.

The authors conlude that the number of cores with HGPIN seems to be associated with the presence of cancer on second biopsy. They receommend a second biopsy at 6 months for all patients with HGPIN when four or more cores with HGPIN are detected in the initial biopsy sample, regardless of the patient’s PSA level.

Filed under: Diagnosis, Risk | Tagged: 12-core biopsy, HGPIN, high-grade prostatic intraepithelial neoplasia, risk |