Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation

Authors

  • Moamen A. Amin Division of Urology, McGill University Health Center, Montréal, Que.
  • Suganthiny Jeyaganth Division of Urology, McGill University Health Center, Montréal, Que.
  • Nader Fahmy Division of Urology, McGill University Health Center, Montréal, Que.
  • Louis Bégin Division of Urology, McGill University Health Center, Montréal, Que.
  • Samuel Aronson Division of Urology, McGill University Health Center, Montréal, Que.
  • Stephen Jacobson Division of Urology, McGill University Health Center, Montréal, Que.
  • Simon Tanguay Division of Urology, McGill University Health Center, Montréal, Que.
  • Armen G. Aprikian Division of Urology, McGill University Health Center, Montréal, Que.

DOI:

https://doi.org/10.5489/cuaj.77

Abstract

Introduction: To evaluate the predictors of prostate cancer in follow-up of patientsdiagnosed on initial biopsy with high-grade prostatic intraepithelial neoplasia(HGPIN) or atypical small acinar proliferation (ASAP).

Methods: We studied 201 patients with HGPIN and 22 patients with ASAPon initial prostatic biopsy who had subsequent prostatic biopsies. The meantime of follow-up was 17.3 months (range 1–62). The mean number of biopsy sessions was 2.5 (range 2–6), and the median number of biopsy cores was10 (range 6–14).

Results: On subsequent biopsies, the rate of prostate cancer was 21.9% (44/201)in HGPIN patients. Of these, 32/201 patients (15.9%), 9/66 patients (13.6%)and 3/18 patients (16.6%) were found to have cancer on the first, second and third follow-up biopsy sessions, respectively. In ASAP patients, the cancer detectionrate was 13/22 (59.1%), all of whom were found on the first follow-upbiopsy. There was a statistically significant difference between the cancer detectionrate in ASAP and HGPIN patients (p < 0.001). Multivariate analysis showedthat the independent predictors of cancer were the number of cores in theinitial biopsy, the number of cores (> 10) in the follow-up biopsy and a prostate specific antigen (PSA) density of ≥ 0.15 (odds ratio 0.77, 3.46 and 2.7,8 respectively;p < 0.04). Conversely, in ASAP patients none of these variables werefound to be associated with cancer diagnosis.

Conclusion: ASAP is a strong predictive factor associated with cancer when comparedwith HGPIN. The factors predictive of cancer on follow-up biopsy ofHGPIN are number of cores on initial biopsy, more than 10 cores in rebiopsyand elevated PSA density. As the cancer detection rate on repeated biopsy of HGPIN patients is the same as that of patients without HGPIN, perhaps the standard of repeat biopsy in all patients with HGPIN should be revisited.

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Published

2012-12-11

How to Cite

Amin, M. A., Jeyaganth, S., Fahmy, N., Bégin, L., Aronson, S., Jacobson, S., Tanguay, S., & Aprikian, A. G. (2012). Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation. Canadian Urological Association Journal, 1(3). https://doi.org/10.5489/cuaj.77

Issue

Vol. 1 No. 3 (2007): CUAJ September

Section

Original Research

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