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High Grade Prostatic
Intraepithelial Neoplasia - One last word (for now). (February 2005)
Since the extended discussion of HGPIN in the December
issue of PCa Commentary, a report on this subject by Moore et al, Albany
Medical College, was published (J Urol, Jan 2005) that is worthy of brief
mention: “Prognostic Significance of HGPIN and Atypical Small Acinar
Proliferation [ASAP] in the Contemporary Era.” The essence of their
observation is that there is a marked decrease in the likelihood of
finding cancer on repeat biopsy if the initial diagnosis of HGPIN
had been found in a 10 to 12 core biopsy, now the contemporary practice.
On the first repeat extended biopsy performed at a median of 4 months
cancer was found in only 1 of 22 men (4.5%) with prior HGPIN, in contrast
to quotations of a 25% to 50% risk when sextant biopsies had been done.
Eleven of these men underwent a second repeat extended biopsy within a
year and no cancer was found. The authors acknowledged that their study
was small, but by combining their results with the larger extended biopsy
studies of Lefkowitz and the M.D.Anderson Cancer Center “only 3 of 103
(2.9%) men with HGPIN would have been found with cancer on repeat biopsy”.
The findings on repeat extended biopsy were very different
for men with a initial diagnosis of ASAP, defined as the “presence of
suspicious glands with insufficient cytological or architectural atypia
for a definitive diagnosis of cancer”. On first repeat biopsy cancer was
found in 19 of 53 (36%), and in 3 of 19 (l6%) on the second repeat biopsy.
Bottom Line:
The current practice of these Albany physicians after finding HGPIN on an
initial extended biopsy is not performing a repeat biopsy, but instead
following with yearly PSA and DRE.
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