What is the prevalence of cancer in patients with precancerous lesions of the prostate?

Updated: Feb 26, 2020
  • Author: Stanley A Brosman, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Borboroglu et al reported cancer detection rates on repeat biopsy ranging from 25-79% for HGPIN and 21-51% for ASAP. [6] (However, the figures for ASAP have also been put at 40-50%.)

In another study, by O'Dowd et al, out of 3030 patients with HGPIN, about 23% were diagnosed with cancer on subsequent biopsy. [7] Davidson et al found cancer in 35% of subsequent biopsy samples in men who had HGPIN and in 13% of subsequent biopsy samples in men without PIN. [8]

Historical studies have been criticized, however, for evaluating samples obtained using sextant needle biopsy, which is no longer the standard technique. Current, extended biopsy schemes obtain 12 or more biopsy cores, depending on the size of the prostate. In some situations, saturation biopsies consisting of more than 20 cores are performed.

Moore et al evaluated the biopsy results of 105 men in whom repeat extended biopsies were performed to further evaluate a finding of HGPIN or ASAP and found that repeat biopsy revealed cancer more often in patients with ASAP than in those with HGPIN. [9] In the HGPIN group, cancer was diagnosed in 1 (4.5%) of 22 men based on first repeat biopsy results and in 0 of 11 based on a second repeat biopsy result. In the ASAP group, in contrast, the first repeat biopsy revealed cancer in 19 (36%) of 53 men and 13 (16%) of 19 on a second repeat biopsy.

In a retrospective study by Leone et al of 264 men who had ASAP identified on prostate biopsy, 34% had prostate cancer identified on repeat biopsy. However, only 22% (8% of the total cohort)  had high-grade disease: 78% had Gleason scores of 3+3 or lower, while 17% had Gleason 7 and 6% had Gleason scores of 8-10 or higher. These authors concluded that most men found to have ASAP do not require immediate repeat biopsy. [10]

McNeal and Bostwick identified PIN in 82% of prostates studied at autopsy in men with cancer, but they identified HGPIN in only 43% of men of similar age who had benign prostatic hyperplasia (BPH). [11] Qian et al found that 86% of 195 whole-mount radical prostatectomy specimens contained HGPIN, which was usually located within 2mm of the cancer. [12] The severity and extent of HGPIN was increased compared with cancer-free prostates.

Although most pathologists recognize the association between HGPIN and prostate cancer, they do not all agree that every HGPIN lesion is necessarily premalignant. A study suggests that on initial biopsy, when HGPIN is stratified into multifocal and bilateral disease, the risk of prostate cancer is significantly increased. [13]


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