Comparative Analysis of Repeat Biopsies in Patients with Isolated High-grade Prostatic Intraepithelial Neoplasia in Their First Prostate Needle Biopsies of 6 Versus 12 Cores and Systematic Literature Review
Comparative Analysis of Repeat Biopsies in Patients with Isolated High-grade Prostatic Intraepithelial Neoplasia in Their First Prostate Needle Biopsies of 6 Versus 12 Cores and Systematic Literature Review
OBJECTIVE The objective of the study was to investigate the relationship between histopathological features of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) and carcinoma risk in repeat prostate needle biopsies of 6 versus 12 cores. METHODS Of 114 isolated HGPIN cases were included; 64 with 6 (1st group) and 50 with 12 cores (2nd group). The number of cores with HGPIN, laterality, structural PIN subtypes, prominent nucleolus, and nuclear pleomorphism was examined in the first and follow-up biopsies. The relationship between the results of follow-up biopsies and clinicopathological findings was evaluated statistically. Furthermore, a systematic literature review was carried out. RESULTS Carcinoma was found in repeat biopsies in 15.6% of the cases in 6-core and 24% of cases with 12-core biopsies (p=0.006). Carcinoma detection rate was significantly higher in cases with ≥2 cores with HGPIN than in cases with a single core of HGPIN (p=0.007). The rates of carcinoma and persistent HGPIN were higher in multifocal and bilateral HGPIN cases, compared to unifocal, or multifocal but unilateral cases (p=0.018). In both groups, prominent nuclear pleomorphism was significantly more common in cases with carcinoma (p=0.023). The systematic literature review revealed 25.6% of carcinoma risk out of 5580 isolated HGPIN patients. CONCLUSION Carcinoma detection rate in repeat biopsies of 12-cores was significantly higher than cases with 6-core biopsies. The HGPIN cases with ≥2 cores, bilaterality, and presence of prominent nuclear pleomorphism were found to be significant histopathological markers in predicting patients with carcinoma. Close follow- up of high risk patients with repeat biopsies in addition to clinical parameters was recommended.
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- 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394–424.
- 2. Epstein JI, Algaba F, Allsbrook WC, Bastacky S, Boccon- Gibod L, De Marzo AM, et al. Acinar adenocarcinoma. In: Eble JN, Sauter G, Epstein JL, Sesterhenn IA, editors. World Health Organisation Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Pres; 2004. p. 162–92.
- 3. McNeal JE, Bostwick DG. Intraductal dysplasia: A premalignant lesion of the prostate. Hum Pathol 1986;17(1):64–71.
- 4. Bostwick DG, Montironi R. Prostatic intraepithelial neoplasia and the origins of prostatic carcinoma. Pathol Res Pract 1995;191(9):828–32.
- 5. Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol 2018;15(1):55–66.
- 6. Merrimen JL, Jones G, Walker D, Leung CS, Kapusta LR, Srigley JR. Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. J Urol 2009;182(2):485–90.
- 7. Bishara T, Ramnani DM, Epstein JI. High-grade prostatic intraepithelial neoplasia on needle biopsy: risk of cancer on repeat biopsy related to number of involved cores and morphologic pattern. Am J Surg Pathol 2004;28(5):629–33.
- 8. Gokden N, Roehl KA, Catalona WJ, Humphrey PA. High-grade prostatic intraepithelial neoplasia in needle biopsy as risk factor for detection of adenocarcinoma: Current level of risk in screening population. Urology 2005;65(3):538–42.
- 9. Girasole CR, Cookson MS, Putzi MJ, Chang SS, Smith JA Jr., Wells N, et al. Significance of atypical and suspicious small acinar proliferations, and high grade prostatic intraepithelial neoplasia on prostate biopsy: İmplications for cancer detection and biopsy strategy. J Urol 2006;175(3 Pt 1):929–33.
- 10. Kim TS, Ko KJ, Shin SJ, Ryoo HS, Song W, Sung HH, et al. Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy. Korean J Urol 2015;56(12):796–802.
- 11. Ongun Ş, Bozkurt O, Çömez K, Demir Ö, Aslan G,Tuna B, et al. Rebiopsy results of the patients in which the first biopsy revealed high grade prostatic intraepithelial neoplasia. Bull Urooncol 2016;15:57–60.
- 12. Kronz JD, Allan CH, Shaikh AA, Epstein JI. Predicting cancer following a diagnosis of high-grade prostatic intraepithelial neoplasia on needle biopsy: Data on men with more than one follow-up biopsy. Am J Surg Pathol 2001;25(8):1079–85.
- 13. Dovey Z, Corbishley CM, Kirby RS. Prostatic intraepithelial neoplasia: A risk factor for prostate cancer. Can J Urol. 2005;12(Suppl 1):49–100.
- 14. Eggener SE, Roehl KA, Catalona WJ. Predictors of subsequent prostate cancer in men with a prostate specific antigen of 2.6 to 4.0 ng/ml and an initially negative biopsy. J Urol 2005;174(2):500–4.
- 15. Joniau S, Goeman L, Pennings J, Van Poppel H. Prostatic intraepithelial neoplasia (PIN): İmportance and clinical management. Eur Urol 2005;48(3):379–85.
- 16. Moore CK, Karikehalli S, Nazeer T, Fisher HA, Kaufman RP Jr., Mian BM. Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J Urol 2005;173(1):70–2.
- 17. Epstein JI, Herawi M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: İmplications for patient care. J Urol 2006;175(3 Pt 1):820–34.
- 18. Herawi M, Kahane H, Cavallo C, Epstein JI. Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. J Urol. 2006;175(1):121–4.
- 19. El-Fakharany MM, Wojno KJ. Significance of high- -grade prostatic intraepithelial neoplasia in the era of extended prostatic needle biopsies. Mod Pathol 2005;18:138A.
- 20. Sakr WGD, Srigley J, Troncoso P. Recent trends regarding the significance of high grade prostatic intraepithelial neoplasia HGPIN in predicting prostate cancer PCA on follow up biopsies. Is there a a change in confirming cancer diagnosis? A multi institutional study. Mod Pathol 2003;16:168A.
- 21. Lee MC, Moussa AS, Zaytoun O, Yu C, Jones JS. Using a saturation biopsy scheme increases cancer detection during repeat biopsy in men with high-grade prostatic intra-epithelial neoplasia. Urology 2011;78(5):1115–9.
- 22. Roscigno M, Scattoni V, Freschi M, Abdollah F, Maccagnano C, Galosi A, et al. Diagnosis of isolated high-grade prostatic intra-epithelial neopla sia: Proposal of a nomogram for the prediction of cancer detection at saturation re-biopsy. BJU Int 2012;109(9):1329–34.
- 23. Pierson DM, Blute MJ, Zincke H. Prostate cancer biopsy and prostatectomy findings with cancer progression rates in men with initial needle biopsies positive for high-grade prostatic intraepithelial neoplasia. Mod Pathol 2004;17:172A.
- 24. Eskicorapci SY, Guliyev F, Islamoglu E, Ergen A, Ozen H. The effect of prior biopsy scheme on prostate cancer detection for repeat biopsy population: Results of the 14-core prostate biopsy technique. Int Urol Nephrol 2007;39(1):189–95.
- 25. Schlesinger C, Bostwick DG, Iczkowski KA. Highgrade prostatic intraepithelial neoplasia and atypical small acinar proliferation: Predictive value for cancer in current practice. Am J Surg Pathol. 2005;29(9):1201–7.
- 26. Siever J, Orychak A, Trpkov K. Prostatic intraepithelial neoplasia, high grade (PIN): Pathologic and clinical findings on initial and repeat ten-core biopsy. Mod Pathol 2003;16:171A.
- 27. O’dowd GJ, Miller MC, Orozco R, Veltri RW. Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology. 2000;55(4):553–9.
- 28. Postma R, Roobol M, Schroder FH, van der Kwast TH. Lesions predictive for prostate cancer in a screened population: first and second screening round findings. Prostate 2004;61(3):260–6.
- 29. Davidson D, Bostwick DG, Qian J, Wollan PC, Oesterling JE, Rudders RA, et al. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: Predictive accuracy in needle biopsies. J Urol 1995;154(4):1295–9.
- 30. Wills ML, Hamper UM, Partin AW, Epstein JI. Incidence of high-grade prostatic intraepithelial neoplasia in sextant needle biopsy specimens. Urology 1997;49(3):367–73.
- 31. Lefkowitz GK, Sidhu GS, Torre P, Lepor H, Taneja SS. Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling? Urology 2001;58(6):999–1003.
- 32. Abdel-Khalek M, El-Baz M, Ibrahiem EH. Predictors of prostate cancer on extended biopsy in patients with high-grade prostatic intraepithelial neoplasia: A multivariate analysis model. BJU Int 2004;94(4):528–33.
- 33. Gallo F, Chiono L, Gastaldi E, Venturino E, Giberti C. Prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN): Risk of prostatic cancer on repeat biopsies. Urology 2008;72(3):628–32.
- 34. Netto GJ, Epstein JI. Widespread high-grade prostatic intraepithelial neoplasia on prostatic needle biopsy: A significant likelihood of subsequently diagnosed adenocarcinoma. Am J Surg Pathol 2006;30(9):1184–8.
- 35. Lee MC, Moussa AS, Yu C, Kattan MW, Magi-Galluzzi C, Jones JS. Multifocal high grade prostatic intraepithelial neoplasia is a risk factor for subsequent prostate cancer. J Urol 2010;184(5):1958–62.