[Clinical significance of prostatic intraepithelial neoplasia]. / Significado clínico de la neoplasia intraepitelial prostática.

ABSTRACT

OBJECTIVE: To determine the value of high grade prostatic intraepithelial neoplasia (with or without the influence of certain risk factors) in predicting prostate cancer in subsequent biopsies. METHODS: The study comprised 41 patients from a prostate cancer screening program with high grade prostatic intraepithelial neoplasia. Subsequent biopsies were reviewed and the probability of detecting prostate cancer was calculated. We analyzed the influence of age, DRE and transrectal US findings, PSA levels and PSA density on the results of the repeat biopsies. RESULTS: The patients were aged 50 to 83 years (mean 62.8 +/- 1.6 SD, median 61). Only 27 of the 41 patients with high grade prostatic intraepithelial neoplasia accepted a repeat biopsy. Of these, prostate cancer was demonstrated in 11 (40.7%; all cases were clinically localized at the time of diagnosis) and 16 showed no changes (59.3%) on repeat biopsy. By univariate and multivariate analysis, patient age, DRE and transrectal US findings, PSA levels and PSA density were not found to be predictors of cancer in the subsequent biopsies. CONCLUSIONS: The finding of high grade prostatic intraepithelial neoplasia in the prostate biopsy carries a high probability of detecting cancer in subsequent biopsies. We therefore advocate performing a repeat biopsy in these patients.