What is the fate of repeat biopsies after diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation?

Year 2013, Volume: 30 Issue: 3, 241 - 245, 05.11.2013

Yakup Bostancı , Ender Ozden , Yarkin Yakupoğlu , Serdar Savascı Ali Yilmaz Saban Sarıkaya

https://doi.org/10.5835/jecm.omu.30.03.007

Abstract

In this study, we reviewed the outcomes of patients undergoing repeat biopsies, following initial diagnosis of high grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) and compared the pathological results to second biopsies due to increased PSA. We retrospectively assessed transrectal ultrasound guided prostate biopsy (TRUSBP) database at our institution between January 2003 and March 2011. Nonparametric tests and binary logistic regression analysis was performed. Among the 1451 TRUSBP taken, 30.4%, 6.4%, 4.7% were diagnosed as prostate carcinoma (PCa), HGPIN, ASAP, respectively. Among patients with HGPIN and ASAP, 68 patients and 48 patients with subsequent biopsies were selected. We also selected 128 patients with diagnosis of benign prostatic tissue (BPT) and subsequent biopsies due to increased PSA. After second biopsy, HGPIN and PCa reported in 29.4% and 20.6%, respectively in HGPIN group; ASAP and PCa was reported in 25% and 37.5%, respectively in ASAP group. Significant increase in PCa rate was reported on second biopsy in ASAP group when compares to HGPIN group (37.5% vs 20.6%, p=0.04) and BPT group (37.5% vs 18.8%, p=0.009). Overall, PCa was diagnosed in 26.5%, 45.8%, 18.8% in HGPIN,
ASAP, BPT groups, respectively. Significant difference in PCa rate was detected only in ASAP group. PSAD has significant effects on PCa in all groups (p=0.001 and p=0.01, respectively). HGPIN is no longer associated with higher risk of cancer. Patients should be followed with yearly prostate specific antigen (PSA) and digital rectal examination (DRE). Repeat biopsy should be made as soon as feasible in patients with ASAP.

Keywords

Atypical small acinar proliferation, biopsy, Prostate carcinoma, Prostatic intraepithelial neoplasia, Prostate specific antigen

References

• Abdel-Khalek, M., El-Baz M., Ibrahiem el, H., 2004. Predictors of prostate cancer on extended biopsy in patients with high-grade prostatic intraepithelial neoplasia: A multivariate analysis model. BJU Int. 94, 528-533.
• Abouassaly, R., Tan, N., Moussa, A., Jones, J.S., Chen, M., 2008. Risk of prostate cancer after diagnosis of atypical glands suspicious for carcinoma on saturation and traditional biopsies. J. Urol. 180, 911-914.
• Babaian, R.J., Toi, A., Kamoi, K., Troncoso, P., Sweet, J., Evans, R., Johnston, D., Chen, M., 2000. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J. Urol, 163, 152-157.
• Bishara, T., Ramnani, D., Epstein, J., 2004. Highgrade 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. 28, 629.
• Borboroglu, P.G., Comer, S.W., Riffenburgh, R.H., Amling, C.L., 2000. Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J. Urol. 163, 158-162.
• Borboroglu, P., Sur, R., Roberts, J., Amling, C., 2001. Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J. Urol. 166, 866-870.
• Bostwick, D., Brawer, M., 1987. Prostatic intraepithelial neoplasia and early invasion in prostate cancer. Cancer. 59, 788.
• Bostwick, D., Srigley, J., Grignon, D., Maksem, J., Humphrey, P., van der Kwast, T.H., Bose, D., Harrison, J., Young, R.H., 1993. Atypical adenomatous hyperplasia of the prostate: Morphologic criteria for its distinction from well-differentiated carcinoma. Hum. Pathol. 24, 819-832. De Nunzio, C., Trucchi, A., Miano, R, Stoppacciaro, A., Fattahi, H., Cicione, A., Tubaro, A., 2009. The number of cores positive for high grade prostatic intraepithelial neoplasia on initial biopsy is associated with prostate cancer on second biopsy. J. Urol. 181, 1069-1074.
• Epstein, J.I., Herawi, M., 2006. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: Implications for patient care. J. Urol. 175, 820-834.
• Eskew, L.A., Bare, R.L., McCullough, D.L., 1997. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J. Urol. 157, 199-202.
• Eskicorapci, S., Guliyev, F., Islamoglu, E., Ergen, A., Ozen, H., 2007. 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. 39, 189–195.
• Fleshner, N.E., O’Sullivan, M., Fair, W.R., 1997. Prevalence and predictors of a positive repeat transrectal ultrasound guided needle biopsy of the prostate. J. Urol. 158, 505-508.
• Gallo, F., Chiono, L., Gastaldi, E., Venturino, E., Giberti, G., 2008. Prognostic significance of high-grade prostatic intraepithelial neoplasia (hgpin): Risk of prostatic cancer on repeat biopsies. Urology. 72, 628–32.
• Girasole, C., Cookson, M., Putzi, M., Chang, S.S., Smith, J.A., Jr., Wells, N., Oppenheimer, J.R., Shappell, S.B., 2006. Significance of atypical and suspicious small acinar proliferations, and high grade prostatic intraepithelial neoplasia on prostate biopsy: Implications for cancer detection and biopsy strategy. J. Urol. 175, 929-933.
• Herawi, M., Kahane, H., Cavallo, C., Epstein, J., 2006. 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. 175, 121-124.
• Iczkowski K., Bassler T., Schwob V., Bassler, I.C., Kunnel, B.S., Orozco, R.E., Bostwick, D.G., 1998. Diagnosis of “suspicious for malignancy” in prostate biopsies: Predictive value for cancer. Urology. 51, 749-757.
• Koca, O., Caliskan, S., Ozturk, M.I., Gunes, M., Karaman, M.I., 2011. Significance of atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in prostate biopsy. Korean J. Urol. 52, 736-740.
• Kronz, J.D., Shaikh, A.A., Epstein, J.I., 2001. High-grade prostatic intraepithelial neoplasia with adjacent small atypical glands on prostate biopsy. Hum. Pathol. 32, 389-395.
• Lefkowitz, G,. Taneja, S., Brown, J., Melamed, J., Lepor, H., 2002. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J. Urol. 168, 1415-1418.
• Leite, K.R., Srougi, M., Dall’Oglio, M.F., Sanudo, A., Camara-Lopes, L.H., 2008. Histopathological findings in extended prostate biopsy with PSA < or = 4 ng/mL. Int. Braz. J. Urol. 34, 283-290.
• Meng, M.V., Shinohara, K., Grossfeld, G.D., 2003. Significance of high-grade prostatic intraepithelial neoplasia on prostate biopsy. Urol. Oncol. 21, 145-151.
• Merrimen, J.L., Jones, G., Walker, D., Leung, C.S., Kapusta, L.R., Srigley, J.R., 2009. Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. J. Urol. 182, 485-490.
• Merrimen, J.L., Jones, G., Hussein, S.A., Leung, C.S., Kapusta, L.R., Srigley, J.R., 2011. A model to predict prostate cancer after atypical findings in initial prostate needle biopsy. J. Urol. 185, 1240-1245.
• Moore, C.K., Karikehalli, S., Nazeer, T., Fisher, H.A., Kaufman, R.P., Jr., Mian, B.M., 2005. Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J. Urol. 173, 70-72.
• Naya, Y., Ayala, A., Tamboli, P., Babaian, R., 2004. Can the number of cores with high-grade prostate intraepithelial neoplasia predict cancer in men who undergo repeat biopsy? Urology. 63, 503-508.
• Netto, G., Epstein, J., 2006. Widespread high-grade prostatic intraepithelial neoplasia on prostatic needle biopsy: A significant likelihood of subsequently diagnosed adenocarcinoma. Am. J. Surg. Pathol. 30, 1184-1188.
• Oderda, M., Gontero, P., 2009. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: Is repeat biopsy still necessary? BJU Int. 104, 1554-1556.
• Presti, J.C., Jr., Chang, J.J., Bhargava, V., Shinohara, K., 2000. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: Results of a prospective clinical trial. J .Urol. 163, 163-166.
• Roehrborn, C.G., Pickens, G.J., Sanders, J.S., 1996. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology. 47, 347-352.
• Roscigno, M., Scattoni, V., Freschi, M., Raber, M., Colombo, R., Bertini, R., Montorsi, F., Rigatti, P., 2004. Monofocal and plurifocal high-grade prostatic intraepithelial neoplasia on extended prostate biopsies: Factors predicting cancer detection on extended repeat biopsy. Urology. 63, 1105-1110.
• Zlotta, A.R., Raviv, G., Schulman, C.C., 1996. Clinical prognostic criteria for later diagnosis of prostate carcinoma in patients with initial isolated prostatic intraepithelial neoplasia. Eur. Urol. 30, 249-255.