Prostatic intraepithelial neoplasia

1868 Non malignant process.

Testosterone has a key role in the growth of this lesion.

Precancerous lesion involving prostatic ducts, ductules, and acini.

Identified in greater than % of benign prostate biopsies.

Two times more common in blacks than whites.

Progression to invasive cancer may take as long as 10 years.

Associated with no symptoms.

Requires no treatment.

Not correlated with PSA levels.

Biopsy of the prostate is the only way to make the diagnosis.

Classified as low or high grade.

Grade of lesion increases with age.

The overall incidence of high-grade PIN in populations undergoing prostate biopsy is about 16%.

High grade PIN characterized by prostatic acini and ducts lined by atypical cells with histochemical and genetic changes similar to those of prostate cancer.

High grade lesions do not invade the basement membrane of the prostate glands.

Low grade PIN not considered to be a significant lesion.

Estimated 30% of patient with high grade PIN will develop prostate cancer within one year.

Patients must be monitored for the development of prostate cancer.

High grade PIN is associated with invasive cancer in 80% of prostate biopsies, and up to 50% of men with isolated prostate cancer confirmed on subsequent biopsy.

When High Grade Prostatic Intraepithelial Neoplasia (HGPIN) is diagnosed on prostate biopsy, in the absence of atypia or actual prostate cancer, follow-up depends on the amount of HGPIN that is seen.

On a biopsy where unifocal changes is seen, suggested repeat PSA and examination testing on a yearly basis and repeat biopsy in three years.

When extensive HGPIN is reported repeat biopsy is suggested at 6 months to a year.

The median risk recorded in the literature for cancer following the diagnosis of HGPIN on needle biopsy is 24.1%,.

This percentage is not much higher than the risk reported in the literature for a repeat biopsy following a benign diagnosis.

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