eMedicine Specialties > Urology > Cancer, Prostate

Precancerous Lesions of the Prostate: Follow-up

Author: Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Contributor Information and Disclosures

Updated: Apr 24, 2009

Follow-up

Further Outpatient Care

  • When high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) has been identified, follow-up care is essential. No clearly established protocol has been established for managing either condition. A part of the problem relates to the amount of HGPIN or ASAP that is present. For example, if HGPIN or ASAP is found in only a 1 of 10 or more biopsy cores, a more limited follow-up protocol would be reasonable. If 6 of 10 cores demonstrate HGPIN or ASAP, a more aggressive program would be appropriate. Repeat prostate biopsies are generally recommended at 6-month intervals for 2 years. If the degree of PIN or ASAP is low, , no additional biopsies would be necessary if the follow-up biopsy finding at 6 months is negative.
    • Prostate cancer has been found in 36% of patients following the second biopsy (ie, the first repeat biopsy), particularly in men with multiple positive cores.
    • Moore et al assert that no additional biopsies are necessary if the first repeat biopsy shows no HGPIN or ASAP, but this is PIN volume–related.8 Neither PIN nor ASAP alone changes the PSA level. A continuously rising PSA level that is doubling at 12 months or less would prompt the need for prostate biopsies, regardless of the presence of PIN or ASAP.
  • The number of biopsies necessary correlates with the size of the prostate and to the presence of palpable lesions. Current biopsy techniques include applying local anesthesia by injecting lidocaine around the base of the prostate and/or instilling lidocaine gel into the rectum.
    • Most urologists obtain at least 8 cores of tissue; if the prostate volume is approximately 40 mL, 12 cores are obtained. The larger the prostate and the higher the level of suspicion, the more cores obtained.
    • PIN and ASAP tend to arise in the peripheral zone of the prostate, which is located on the posterior surface of the prostate, arching anteriorly on each side. Ultrasonographic studies help to understand the anatomy and to develop a reasonable biopsy strategy for each patient. Color Doppler and MRI are used to visualize the prostate, but they do not reveal PIN or ASAP and often cannot be used to distinguish cancer from areas of inflammation.

Inpatient & Outpatient Medications

  • Antibiotics are prescribed on the day of a prostate biopsy and, often, for the following day.
  • Most authorities do not recommend treating patients with a single focus of HGPIN. ASAP represents a potentially more serious situation; if ASAP is confirmed on subsequent biopsy, therapy should be considered. Most urologists do not treat these conditions, whereas others have advocated the use of 5-alpha reductase inhibitors, anti-inflammatory agents, SERMs, and dietary supplements (eg, selenium, lycopene). Few data have been collected on the use of dietary measures to manage these patients.
    • If HGPIN is present on only a single core, the only course of action that seems reasonable is to observe the patient at 6-month intervals with PSA measurements and digital rectal examination.
    • If multiple biopsy cores demonstrate HGPIN, a repeat biopsy at 6 months is recommended. If multiple cores of HGPIN are still present (without cancer), a biopsy should be repeated in another 6 months. If the findings persist, some type of therapy may be considered.
    • The finding of ASAP in one or more biopsy samples necessitates a follow-up biopsy in 6 months. Repeated findings of ASAP may encourage the urologist to initiate therapy.

Deterrence/Prevention

No known measures that prevent the development of HGPIN or ASAP have been identified. Numerous agents, including finasteride, bicalutamide, selenium, vitamin E, soy isoflavonoids, and toremifene, have been studied to determine their ability to eradicate HGPIN.

Complications

The only potential complication of HGPIN or ASAP is the development of prostate adenocarcinoma.

Prognosis

  • The prognostic significance of HGPIN and ASAP is related to possible development of prostate cancer. HGPIN and ASAP are important because they are frequently associated with cancer, although their presence does not necessarily imply that prostate cancer is inevitable. The grade and stage of prostate cancer has prognostic significance, but the presence of HGPIN or ASAP does not alter this prognosis.
  • The importance of recognizing HGPIN and ASAP relates to their association with prostatic carcinoma. HGPIN may remain stable for years in many patients, regress in some, or progress to invasive cancer.

Patient Education

  • Patients with HGPIN or ASAP not associated with an existing prostate cancer should be informed about the need for surveillance because they are at an increased risk for developing prostate cancer. Patients should be informed that neither HGPIN nor ASAP affects PSA levels.
  • Regular PSA measurements and physical examinations should be performed every 6 months. Patients with HGPIN who have only a single biopsy core demonstrating HGPIN do not need additional biopsies. Patients with multiple cores of HGPIN or even one biopsy core positive for ASAP should have repeat biopsies at 6-month intervals for at least 2 years.

Miscellaneous

Medicolegal Pitfalls

  • Failing to diagnose high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) is not nearly as important as failing to diagnose prostate cancer. However, a physician who fails to carefully monitor a patient with PIN or ASAP and to inform him that he may be at increased risk for developing prostate cancer is not serving the best interests of the patient.
  • The presence of HGPIN or ASAP should alert the physician to the possibility of an existing cancer and to the patient’s heightened risk of developing prostate cancer in the future.

Special Concerns

  • HGPIN is generally diagnosed without difficulty. ASAP includes various microscopic entities such as lobular atrophy, postatrophic hyperplasia, atypical basal cell hyperplasia, atypical adenomatous hyperplasia, cribriform hyperplasia, radiation-induced metaplasia, infarction, and prostatitis. Inflammatory atypia of the benign epithelium is the most frequently encountered cellular change that mimics HGPIN. In the presence of acute or chronic inflammation, the diagnosis of HGPIN or ASAP can be very difficult to confirm, and non-PIN lesions show architectural and cytologic alterations, including cytologic abnormalities, that can be confused with HGPIN.
  • HGPIN and ASAP are difficult, if not impossible, to recognize following radiation therapy. The cytologic changes caused by radiation therapy have many similarities to those associated with HGPIN. Nevertheless, Arakawa et al found that the frequency of HGPIN in radical prostatectomy specimens obtained following radiation therapy was similar to the rate found in nonradiated prostatectomy specimens.17
  • Cribriform adenocarcinoma, ductal carcinoma, and urothelial carcinoma involving prostatic ducts and acini are malignant lesions that may also be confused with HGPIN.
  • ASAP is considered to be precancerous and has a greater association with prostate cancer than HGPIN. ASAP is characterized by localized proliferation of small acini that may be confused with cancer. These lesions are usually found in intimate association with nodular hyperplasia in the transition zone, often at the periphery of a nodule. Cytologic and histologic features distinguish ASAP from PIN, but differentiating ASAP from cancer may be very difficult.
  • Despite the apparent survival advantage of early diagnosis conferred by PSA screening, a recent U.S. Preventive Services Task Force statement recommends against screening for prostate cancer in men aged 75 years or older. The statement also concludes that, currently, the balance of benefits versus drawbacks of prostate cancer screening in men younger than age 75 years cannot be assessed because of insufficient evidence.18
 


More on Precancerous Lesions of the Prostate

Overview: Precancerous Lesions of the Prostate
Differential Diagnoses & Workup: Precancerous Lesions of the Prostate
Treatment & Medication: Precancerous Lesions of the Prostate
Follow-up: Precancerous Lesions of the Prostate
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bostwick DG, Brawer MK. Prostatic intra-epithelial neoplasia and early invasion in prostate cancer. Cancer. Feb 15 1987;59(4):788-94. [Medline].

  2. Bostwick DG, Amin MB, Dundore P, Marsh W, Schultz DS. Architectural patterns of high-grade prostatic intraepithelial neoplasia. Hum Pathol. Mar 1993;24(3):298-310. [Medline].

  3. De Marzo AM, Nakai Y, Nelson WG. Inflammation, atrophy, and prostate carcinogenesis. Urol Oncol. Sep-Oct 2007;25(5):398-400. [Medline].

  4. Orozco R, O'Dowd G, Kunnel B, Miller MC, Veltri RW. Observations on pathology trends in 62,537 prostate biopsies obtained from urology private practices in the United States. Urology. Feb 1998;51(2):186-95. [Medline].

  5. Novis DA, Zarbo RJ, Valenstein PA. Diagnostic uncertainty expressed in prostate needle biopsies. A College of American Pathologists Q-probes Study of 15,753 prostate needle biopsies in 332 institutions. Arch Pathol Lab Med. Aug 1999;123(8):687-92. [Medline].

  6. Borboroglu PG, Comer SW, Riffenburgh RH, Amling CL. Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol. Jan 2000;163(1):158-62. [Medline].

  7. O'dowd GJ, Miller MC, Orozco R, Veltri RW. Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology. Apr 2000;55(4):553-9. [Medline].

  8. Moore CK, Karikehalli S, Nazeer T, Fisher HA, Kaufman RP Jr, Mian BM. Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J Urol. Jan 2005;173(1):70-2. [Medline].

  9. McNeal JE, Bostwick DG. Intraductal dysplasia: a premalignant lesion of the prostate. Hum Pathol. Jan 1986;17(1):64-71. [Medline].

  10. Qian J, Wollan P, Bostwick DG. The extent and multicentricity of high-grade prostatic intraepithelial neoplasia in clinically localized prostatic adenocarcinoma. Hum Pathol. Feb 1997;28(2):143-8. [Medline].

  11. Alsikafi NF, Brendler CB, Gerber GS, Yang XJ. High-grade prostatic intraepithelial neoplasia with adjacent atypia is associated with a higher incidence of cancer on subsequent needle biopsy than high-grade prostatic intraepithelial neoplasia alone. Urology. Feb 2001;57(2):296-300. [Medline].

  12. Montironi R, Mazzucchelli R, Scarpelli M. Precancerous lesions and conditions of the prostate: from morphological and biological characterization to chemoprevention. Ann N Y Acad Sci. Jun 2002;963:169-84. [Medline].

  13. Petein M, Michel P, van Velthoven R, Pasteels JL, Brawer MK, Davis JR, et al. Morphonuclear relationship between prostatic intraepithelial neoplasia and cancers as assessed by digital cell image analysis. Am J Clin Pathol. Nov 1991;96(5):628-34. [Medline].

  14. Amin MB, Ro JY, Ayala AG. Putative precursor lesions of prostatic adenocarcinoma: fact or fiction?. Mod Pathol. Jul 1993;6(4):476-83. [Medline].

  15. Davidson D, Bostwick DG, Qian J, Wollan PC, Oesterling JE, Rudders RA, et al. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies. J Urol. Oct 1995;154(4):1295-9. [Medline].

  16. Yamauchi A, Kawai K, Tsukamoto S, Ideyama Y, Shirai T, Akaza H. Persistence of prostatic intraepithelial neoplasia after effective chemoprevention of microscopic prostate cancer with antiandrogen in a rat model. J Urol. Jan 2006;175(1):348-52. [Medline].

  17. Arakawa A, Song S, Scardino PT, Wheeler TM. High grade prostatic intraepithelial neoplasia in prostates removed following irradiation failure in the treatment of prostatic adenocarcinoma. Pathol Res Pract. Sep 1995;191(9):868-72. [Medline].

  18. [Best Evidence] U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Aug 5 2008;149(3):185-91. [Medline].

  19. Akhavan A, Keith JD, Bastacky SI, Cai C, Wang Y, Nelson JB. The proportion of cores with high-grade prostatic intraepithelial neoplasia on extended-pattern needle biopsy is significantly associated with prostate cancer on site-directed repeat biopsy. BJU Int. Apr 2007;99(4):765-9. [Medline].

  20. Allam CK, Bostwick DG, Hayes JA, Upton MP, Wade GG, Domanowski GF, et al. Interobserver variability in the diagnosis of high-grade prostatic intraepithelial neoplasia and adenocarcinoma. Mod Pathol. Jul 1996;9(7):742-51. [Medline].

  21. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol. Jan 2000;163(1):152-7. [Medline].

  22. Bigler SA, Deering RE, Brawer MK. Comparison of microscopic vascularity in benign and malignant prostate tissue. Hum Pathol. Feb 1993;24(2):220-6. [Medline].

  23. Bishara T, Ramnani DM, Epstein JI. High-grade prostatic intraepithelial neoplasia on needle biopsy: risk of cancer on repeat biopsy related to number of involved cores and morphologic pattern. Am J Surg Pathol. May 2004;28(5):629-33. [Medline].

  24. Bostwick DG. c-erbB-2 oncogene expression in prostatic intraepithelial neoplasia: mounting evidence for a precursor role. J Natl Cancer Inst. Aug 3 1994;86(15):1108-10. [Medline].

  25. Bostwick DG. High grade intraepithelial neoplasia. The most likely precursor of prostate cancer. Cancer. 1995;75:1823-1836.

  26. Bostwick DG. Premalignant lesions of the prostate. Semin Diagn Pathol. Aug 1988;5(3):240-53. [Medline].

  27. Bostwick DG. Prospective origins of prostate carcinoma. Prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia. Cancer. Jul 15 1996;78(2):330-6. [Medline].

  28. Bostwick DG. Prostatic intraepithelial neoplasia (PIN): current concepts. J Cell Biochem Suppl. 1992;16H:10-9. [Medline].

  29. Bostwick DG, Algaba F, Amin MB, Ayala A, Eble J, Goldstein N, et al. Consensus statement on terminology: recommendation to use atypical adenomatous hyperplasia in place of adenosis of the prostate. Am J Surg Pathol. Oct 1994;18(10):1069-70. [Medline].

  30. Bostwick DG, Dousa MK, Crawford BG, Wollan PC. Neuroendocrine differentiation in prostatic intraepithelial neoplasia and adenocarcinoma. Am J Surg Pathol. Dec 1994;18(12):1240-6. [Medline].

  31. Bostwick DG, Neumann R, Qian J, Cheng L. Reversibility of prostatic intraepithelial neoplasia: implications for chemoprevention. Eur Urol. 1999;35(5-6):492-5. [Medline].

  32. Bostwick DG, Pacelli A, Lopez-Beltran A. Molecular biology of prostatic intraepithelial neoplasia. Prostate. Aug 1996;29(2):117-34. [Medline].

  33. Bostwick DG, Qian J, Frankel K. The incidence of high grade prostatic intraepithelial neoplasia in needle biopsies. J Urol. Nov 1995;154(5):1791-4. [Medline].

  34. Brand TC, Thibault GP, Basler JW. Dealing with non-cancerous findings on prostate biopsy. Curr Urol Rep. May 2006;7(3):186-92. [Medline].

  35. Brawer MK, Bigler SA, Sohlberg OE, Nagle RB, Lange PH. Significance of prostatic intraepithelial neoplasia on prostate needle biopsy. Urology. Aug 1991;38(2):103-7. [Medline].

  36. Brimo F, Vollmer RT, Corcos J, Humphrey PA, Bismar TA. Outcome for repeated biopsy of the prostate: roles of serum PSA, small atypical glands, and prostatic intraepithelial neoplasia. Am J Clin Pathol. Oct 2007;128(4):648-51. [Medline].

  37. Chappell B, McLoughlin J. Technical considerations when obtaining and interpreting prostatic biopsies from men with suspicion of early prostate cancer: part 2. BJU Int. Jun 2005;95(8):1141-5. [Medline].

  38. Che M, Sakr W, Grignon D. Pathologic features the urologist should expect on a prostate biopsy. Urol Oncol. Mar-Apr 2003;21(2):153-61. [Medline].

  39. Dawson DM, Lawrence EG, MacLennan GT, Amini SB, Kung HJ, Robinson D, et al. Altered expression of RET proto-oncogene product in prostatic intraepithelial neoplasia and prostate cancer. J Natl Cancer Inst. Apr 1 1998;90(7):519-23. [Medline].

  40. de la Torre M, Häggman M, Brändstedt S, Busch C. Prostatic intraepithelial neoplasia and invasive carcinoma in total prostatectomy specimens: distribution, volumes and DNA ploidy. Br J Urol. Aug 1993;72(2):207-13. [Medline].

  41. Epstein JI, Grignon DJ, Humphrey PA, McNeal JE, Sesterhenn IA, Troncoso P, et al. Interobserver reproducibility in the diagnosis of prostatic intraepithelial neoplasia. Am J Surg Pathol. Aug 1995;19(8):873-86. [Medline].

  42. Epstein JI, Herawi M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol. Mar 2006;175(3 Pt 1):820-34. [Medline].

  43. Epstein JI, Potter SR. The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. J Urol. Aug 2001;166(2):402-10. [Medline].

  44. Ferguson J, Zincke H, Ellison E, Bergstrahl E, Bostwick DG. Decrease of prostatic intraepithelial neoplasia following androgen deprivation therapy in patients with stage T3 carcinoma treated by radical prostatectomy. Urology. Jul 1994;44(1):91-5. [Medline].

  45. Flury SC, Galgano MT, Mills SE, Smolkin ME, Theodorescu D. Atypical small acinar proliferation: biopsy artefact or distinct pathological entity?. BJU Int. Apr 2007;99(4):780-5. [Medline].

  46. Giannulis I, Montironi R, Galluzzi CM, de Nictolis M, Diamanti L. Frequency and location of mitoses in prostatic intraepithelial neoplasia (PIN). Anticancer Res. Nov-Dec 1993;13(6B):2447-51. [Medline].

  47. Gore JL, Shariat SF, Miles BJ, Kadmon D, Jiang N, Wheeler TM, et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol. May 2001;165(5):1554-9. [Medline].

  48. Graham SD Jr, Bostwick DG, Hoisaeter A, Abrahamsson P, Algaba F, di Sant'Agnese A, et al. Report of the Committee on Staging and Pathology. Cancer. Jul 1 1992;70(1 Suppl):359-61. [Medline].

  49. Häggman MJ, Adolfsson J, Khoury S, Montie JE, Norlén J. Clinical management of premalignant lesions of the prostate. WHO Collaborative Project and Consensus Conference on Public Health and Clinical Significance of Premalignant Alterations in the Genitourinary Tract. Scand J Urol Nephrol Suppl. 2000;(205):44-9. [Medline].

  50. Izawa JI, Lega I, Downey D, Chin JL, Luke PP. Do all patients with high-grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?. BJU Int. Aug 2005;96(3):320-3. [Medline].

  51. Joniau S, Goeman L, Roskams T, Lerut E, Oyen R, Van Poppel H. Effect of nutritional supplement challenge in patients with isolated high-grade prostatic intraepithelial neoplasia. Urology. Jun 2007;69(6):1102-6. [Medline].

  52. Kang TY, Nichols P, Skinner E, Groshen S, Valin G, Ye W, et al. Functional heterogeneity of prostatic intraepithelial neoplasia: the duration of hormonal therapy influences the response. BJU Int. May 2007;99(5):1024-7. [Medline].

  53. Keetch DW, Humphrey P, Stahl D, Smith DS, Catalona WJ. Morphometric analysis and clinical followup of isolated prostatic intraepithelial neoplasia in needle biopsy of the prostate. J Urol. Aug 1995;154(2 Pt 1):347-51. [Medline].

  54. Kronz JD, Shaikh AA, Epstein JI. High-grade prostatic intraepithelial neoplasia with adjacent small atypical glands on prostate biopsy. Hum Pathol. Apr 2001;32(4):389-95. [Medline].

  55. Lefkowitz GK, Sidhu GS, Torre P, Lepor H, Taneja SS. Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?. Urology. Dec 2001;58(6):999-1003. [Medline].

  56. Li Z, Szabolcs M, Terwilliger JD, Efstratiadis A. Prostatic intraepithelial neoplasia and adenocarcinoma in mice expressing a probasin-Neu oncogenic transgene. Carcinogenesis. May 2006;27(5):1054-67. [Medline].

  57. López JI. Prostate adenocarcinoma detected after high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. BJU Int. Dec 2007;100(6):1272-6. [Medline].

  58. Mallén E, Gil P, Sancho C, Jesús Gil M, Allepuz C, Borque A, et al. Atypical small acinar proliferation: review of a series of 64 patients. Scand J Urol Nephrol. 2006;40(4):272-5. [Medline].

  59. Maygarden SJ, Strom S, Ware JL. Localization of epidermal growth factor receptor by immunohistochemical methods in human prostatic carcinoma, prostatic intraepithelial neoplasia, and benign hyperplasia. Arch Pathol Lab Med. Mar 1992;116(3):269-73. [Medline].

  60. McNeal JE, Alroy J, Leav I, Redwine EA, Freiha FS, Stamey TA. Immunohistochemical evidence for impaired cell differentiation in the premalignant phase of prostate carcinogenesis. Am J Clin Pathol. Jul 1988;90(1):23-32. [Medline].

  61. Meng MV, Shinohara K, Grossfeld GD. Significance of high-grade prostatic intraepithelial neoplasia on prostate biopsy. Urol Oncol. Mar-Apr 2003;21(2):145-51. [Medline].

  62. Montironi R, Braccischi A, Matera G, Scarpelli M, Pisani E. Quantitation of the prostatic intra-epithelial neoplasia. Analysis of the nucleolar size, number and location. Pathol Res Pract. Mar 1991;187(2-3):307-14. [Medline].

  63. Montironi R, Mazzucchelli R, Lopez-Beltran A, Cheng L, Scarpelli M. Mechanisms of disease: high-grade prostatic intraepithelial neoplasia and other proposed preneoplastic lesions in the prostate. Nat Clin Pract Urol. Jun 2007;4(6):321-32. [Medline].

  64. Myers RB, Srivastava S, Oelschlager DK, Grizzle WE. Expression of p160erbB-3 and p185erbB-2 in prostatic intraepithelial neoplasia and prostatic adenocarcinoma. J Natl Cancer Inst. Aug 3 1994;86(15):1140-5. [Medline].

  65. Nagle RB, Brawer MK, Kittelson J, Clark V. Phenotypic relationships of prostatic intraepithelial neoplasia to invasive prostatic carcinoma. Am J Pathol. Jan 1991;138(1):119-28. [Medline].

  66. Netto GJ, Epstein JI. Widespread high-grade prostatic intraepithelial neoplasia on prostatic needle biopsy: a significant likelihood of subsequently diagnosed adenocarcinoma. Am J Surg Pathol. Sep 2006;30(9):1184-8. [Medline].

  67. Pierorazio PM, Lambert SM, Matsukhani M, Sprenkle PC, McCann TR, Katz AE, et al. High-grade prostatic intraepithelial neoplasia is an independent predictor of outcome after radical prostatectomy. BJU Int. Nov 2007;100(5):1066-70. [Medline].

  68. Postma R, Schröder FH, van der Kwast TH. Atrophy in prostate needle biopsy cores and its relationship to prostate cancer incidence in screened men. Urology. Apr 2005;65(4):745-9. [Medline].

  69. Presti JC Jr. Prostate biopsy strategies. Nat Clin Pract Urol. Sep 2007;4(9):505-11. [Medline].

  70. Qian J, Jenkins RB, Bostwick DG. Genetic and chromosomal alterations in prostatic intraepithelial neoplasia and carcinoma detected by fluorescence in situ hybridization. Eur Urol. 1999;35(5-6):479-83. [Medline].

  71. Raghow S, Hooshdaran MZ, Katiyar S, Steiner MS. Toremifene prevents prostate cancer in the transgenic adenocarcinoma of mouse prostate model. Cancer Res. Mar 1 2002;62(5):1370-6. [Medline].

  72. Ramos CG, Carvahal GF, Mager DE, Haberer B, Catalona WJ. The effect of high grade prostatic intraepithelial neoplasia on serum total and percentage of free prostate specific antigen levels. J Urol. Nov 1999;162(5):1587-90. [Medline].

  73. Reynolds T. Trials examine intraepithelial neoplasia as a marker for cancer. J Natl Cancer Inst. Feb 5 2003;95(3):182-4. [Medline].

  74. Ronnett BM, Carmichael MJ, Carter HB, Epstein JI. Does high grade prostatic intraepithelial neoplasia result in elevated serum prostate specific antigen levels?. J Urol. Aug 1993;150(2 Pt 1):386-9. [Medline].

  75. Sakr WA. High-grade prostatic intraepithelial neoplasia: additional links to a potentially more aggressive prostate cancer?. J Natl Cancer Inst. Apr 1 1998;90(7):486-7. [Medline].

  76. Sakr WA. Prostatic intraepithelial neoplasia: A marker for high-risk groups and a potential target for chemoprevention. Eur Urol. 1999;35(5-6):474-8. [Medline].

  77. Sakr WA, Grignon DJ, Haas GP, Schomer KL, Heilbrun LK, Cassin BJ, et al. Epidemiology of high grade prostatic intraepithelial neoplasia. Pathol Res Pract. Sep 1995;191(9):838-41. [Medline].

  78. Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol. Aug 1993;150(2 Pt 1):379-85. [Medline].

  79. San Francisco IF, Olumi AF, Kao J, Rosen S, DeWolf WC. Clinical management of prostatic intraepithelial neoplasia as diagnosed by extended needle biopsies. BJU Int. Mar 2003;91(4):350-4. [Medline].

  80. Scattoni V, Montironi R, Mazzucchelli R, Freschi M, Nava L, Losa A, et al. Pathological changes of high-grade prostatic intraepithelial neoplasia and prostate cancer after monotherapy with bicalutamide 150 mg. BJU Int. Jul 2006;98(1):54-8. [Medline].

  81. Schlesinger C, Bostwick DG, Iczkowski KA. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: predictive value for cancer in current practice. Am J Surg Pathol. Sep 2005;29(9):1201-7. [Medline].

  82. Schoenfield L, Jones JS, Zippe CD, Reuther AM, Klein E, Zhou M, et al. The incidence of high-grade prostatic intraepithelial neoplasia and atypical glands suspicious for carcinoma on first-time saturation needle biopsy, and the subsequent risk of cancer. BJU Int. Apr 2007;99(4):770-4. [Medline].

  83. Sofikerim M, Tatlisen A, Karacagil M. Do all patients with high-grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?. BJU Int. Apr 2006;97(4):869-70. [Medline].

  84. Steiner MS, Pound CR. Phase IIA clinical trial to test the efficacy and safety of Toremifene in men with high-grade prostatic intraepithelial neoplasia. Clin Prostate Cancer. Jun 2003;2(1):24-31. [Medline].

  85. Steiner MS, Raghow S. Antiestrogens and selective estrogen receptor modulators reduce prostate cancer risk. World J Urol. May 2003;21(1):31-6. [Medline].

  86. Weinstein MH, Epstein JI. Significance of high-grade prostatic intraepithelial neoplasia on needle biopsy. Hum Pathol. Jun 1993;24(6):624-9. [Medline].

  87. Yamamoto S, Ito T, Aizawa T, Miki M, Furusato M. The possibility of 'de novo' cancer in the prostate. Int J Urol. Apr 2005;12(4):361-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

For more information, see Medscape’s Prostate Cancer Resource Center.

[ CLOSE WINDOW ]

Keywords

prostatic intraepithelial neoplasia, prostate cancer, prostatic adenocarcinoma, prostate adenocarcinoma, PIN, high-grade prostatic intraepithelial neoplasia, low-grade prostatic intraepithelial neoplasia, high-grade PIN, HGPIN, low-grade PIN, LGPIN, atypical small acinar proliferation, ASAP, intraductal hyperplasia, prostatic hyperplasia with malignant change, precursor lesions, large acinar atypical hyperplasia, marked atypia, ductal-acinar dysplasia, benign prostatic hyperplasia, BPH, atypical adenomatous hyperplasia (AAH), adenosis, prostate-specific antigen, PSA, digital rectal examination, DRE, proliferative inflammatory atrophy, lobular atrophy, postatrophic hyperplasia, atypical basal cell hyperplasia, cribriform hyperplasia, radiation-induced metaplasia, prostatitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, American Urological Association, Association of Clinical Research Professionals, International Society of Urological Pathology, Société Internationale d'Urologie (International Society of Urology), Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, and Western Section American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Professor, Department of Urology, College of Physicians and Surgeons, Columbia University; Director of Urology, Allen Pavilion, New York Presbyterian Hospital
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.