Initial High Grade Prostatic Intraepithelial Neoplasia (HGPIN) with Carcinoma on Subsequent Prostate Needle Biopsy: Findings at Radical Prostatectomy.
Turki Alhussain, Jonathan Epstein. The Johns Hopkins Hospital, Baltimore, MD
Background: There are only a few small studies on men with an initial biopsy showing HGPIN who later have cancer on repeat biopsy and then undergone radical prostatectomy. It is unknown whether this scenario impacts the prognosis of the subsequent radical prostatectomy.
Design: We compared radical prostatectomy findings in 45 men with an initial diagnosis of HGPIN who subsequently were diagnosed with cancer to 18,450 men diagnosed with cancer who lacked a prior diagnosis of HGPIN. All cases were retrieved from our institution between 1993 and 2008.
Results: The mean patient age was 60.2 years and the mean serum PSA value was 9.0 ng/mL. for the 45 men with an initial HGPIN diagnosis. 21/45 (46.7%) men were found to have cancer within 6 months and 29/45 (64.4%) within 1 year following the diagnosis of HGPIN. Cancer involved a single core in 32/45 (71.1%) and the maximum tumor volume was 5% in 59.1% of the 45 cases. Men with initial HGPIN had 84.4% organ confined cancer while cases without HGPIN had 65.4% organ confined cancer (p=0.007) at radical prostatectomy. Favorable pathologic stage was maintained even when we restricted the analysis to men with only Gleason score 6 cancer on biopsy. In men with Gleason score 6 cancer on biopsy, men with an initial diagnosis of HGPIN had 88.9% organ confined vs. 73.2% for men with no prior biopsy diagnosis of HGPIN, (p=0.03). For all men, there was no significant difference in Gleason score at radical prostatectomy between the two groups. Gleason score was ≤ 6 in 79.6% and 73.6% for men with and without a prior HGPIN diagnosis on biopsy, respectively.
Conclusions: Prostatic adenocarcinomas discovered after an initial HGPIN diagnosis on biopsy are more likely to be organ confined, yet of similar grade compared to cases diagnosed as cancer on the first biopsy. These findings likely reflect cancers associated with HGPIN, where the cancers were missed on the initial biopsy as a result of smaller size.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 73, Wednesday Morning