High-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor to invasive prostate cancer observed as an isolated entity in a growing subset of men undergoing prostate biopsy. High-grade PIN and prostate cancer are morphometrically and phenotypically similar. Studies have indicated that about 16% of low-grade PIN can lead to prostate …

Prostatic intraepithelial neoplasia (PIN) diagnosis and grading are affected by uncertainties which arise from the fact that almost all knowledge of PIN histopathology is expressed in concepts, descriptive linguistic terms, and words.

High-grade PIN occurs primarily in the peripheral zone and is seen in areas that are in continuity with prostate cancer.HGPIN and ASAP are prostate biopsy findings in between benign and malignant diagnoses, which indicate the need for close follow-up. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic …

When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. and you may need to create a new Wiley Online Library account.Enter your email address below and we will send you your usernameIf the address matches an existing account you will receive an email with instructions to retrieve your username

High Grade Prostatic Intraepithelial Neoplasia on Needle Biopsy.

Epstein JI, Allsbrook WC, Jr, Amin MB, Egevad LL, Committee IG.

Given that there are an estimated 1,300,000 prostate biopsies performed annually, a reasonable estimate is that there are about 115,000 new cases annually of high-grade PIN without cancer and a prevalence of more than 16 million (The relationship between the number of cores sampled and the incidence of PIN on needle biopsy is controversial, although most agree that greater sampling increases the yield of both PIN and cancer.

Most urologists, doctors who treat men with reproductive organ disorders, may ask patients to have another check up and a biopsy a year later for monitoring. We routinely use these important techniques in the diagnostic workup of atypical prostate lesions seen in needle biopsy specimens and thereby decrease the incidence of an ASAP diagnosis and reduce the risk of false-negative results and the need for additional biopsies similar to other reports.The decreasing association between high-grade PIN and carcinoma is due toIncreased number of cores performed per biopsy procedure with better targeting of peripheral zoneChanging patient population (younger, PSA screened) with lower prevalence or lower volume of adenocarcinoma; bayesian reasoning dictates that the positive predictive value of any test result (high-grade PIN on biopsy) is a function of the prevalence of disease (carcinoma) in the population being testedDiagnosis of high-grade PIN should be made conservatively (cells must show both nucleomegaly and nucleolomegaly)The differential diagnosis of HGPIN includes several benign and malignant lesions. This double-blind placebo-controlled trial included 18,882 males aged 55 years and older who were randomized to finasteride, a 5-AR inhibitor, at 5 mg or placebo daily for seven years. In one report, the investigators found that sampling only the side or sextant site initially diagnosed as ASAP missed cancer in 39% of patients whose cancer was later detected exclusively at other sites; this finding suggested that the entire prostate should undergo repeat biopsy.In a provocative report, the investigators recommended immediate radical prostatectomy in patients with the biopsy diagnosis of ASAP. The presence of HGPIN predicts an increased risk of 1) coexisting occult prostate cancer at baseline and 2) delayed progression to prostate cancer.