The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia.
clinically significant prostate cancer
high-grade intraepithelial neoplasia
insignificant prostate cancer
multiparametric MRI
repeat prostate biopsy
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
15
07
2021
received:
08
02
2021
accepted:
07
08
2021
pubmed:
11
8
2021
medline:
14
5
2022
entrez:
10
8
2021
Statut:
ppublish
Résumé
To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies. A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and who underwent repeat biopsy within 1 to 3 years, was analysed. Pre-repeat biopsy mpMRI and guided biopsies to suspicious lesions (Prostate Imaging - Reporting and Data System [PI-RADS] ≥3) and/or and systematic biopsies were performed. Persistent prostate cancer (PCa) suspicion, defined as sustained serum prostate-specific antigen level >4 ng/mL and/or abnormal digital rectal examination, was present in 248 men (84.6%), and was absent in 45 men (15.4%). A control group of 190 men who had no previous HGPIN, atypical small acinar proliferation or HGPIN with atypia who were scheduled to undergo repeat biopsy due to persistent PCa suspicion were also analysed. csPCa was defined as tumours of Grade Group ≥2. In the subset of 45 men with isolated HGPIN, in whom PCa suspicion disappeared, only one csPCa (2.2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34.7% of men with persistent PCa suspicion and previous HGPIN, and in 28.4% of those without previous HGPIN (P =0.180). iPCa was detected in 12.1% and 6.3%, respectively (P =0.039). Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN: odds ratio (OR) 1.369 (95% confidence interval [CI] 0.894-2.095; P =0.149); however, previous HGPIN increased the risk of iPCa detection: OR 2.043 (95% CI 1.016-4.109; P =0.006). The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
627-633Informations de copyright
© 2021 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
Références
McNeal JE. Bostwick DG· Intraductal dysplasia: a premalignant lesion of the prostate. Hum Pathol 1986; 17: 64-71
Bostwick DG, Brawer MK. Prostatic Intra-Epithelial Neoplasia and Early Invasion in Prostate Cancer. Cancer 1987; 59: 788-94
Kronz JD, Allan CH, Shaikh AA, Epstein JI. Predicting cancer following a diagnosis of high-grade prostatic intraepithelial neoplasia on needle biopsy: data on men with more than one follow-up biopsy. Am J Surg Pathol 2001; 25: 1079-85
Epstein JI, Heraw M. Prostate Needle Biopsies Containing Prostatic Intraepithelial Neoplasia or Atypical Foci Suspicious for Carcinoma: Implications for Patient Care. J Urol 2006; 175: 820-34
Merrimen JL, Jones G, Walker D, Leung CS, Kapusta LR, Srigley JR. Multifocal High Grade Prostatic Intraepithelial Neoplasia is a Significant Risk Factor for Prostatic Adenocarcinoma. J Urol 2009; 182: 485-90
Manning TG, Cheung E, Perera M et al. Atypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review. Urology 2017; 107: 5-10
Mottet N, van den Bergh RCN, Briers E et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021; 79: 243-62
Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol 2018; 15: 55-66
Srirangam V, Rai BP, Abroaf A et al. Atypical Small Acinar Proliferation and High Grade Prostatic Intraepithelial Neoplasia: Should We Be Concerned? An Observational Cohort Study with a Minimum Follow-Up of 3 Years. Curr Urol 2017; 10: 199-205
Wiener S, Haddock P, Cusano J et al. Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue. Urology 2017; 110: 161-5
Prathibha S, Goyal KG, Zynger DL. Initial diagnosis of insignificant cancer, high-grade prostatic intraepithelial neoplasia, atypical small acinar proliferation, and negative have the same rate of upgrade to a Gleason score of 7 or higher on repeat prostate biopsy. Hum Pathol 2018; 79: 116-21
Abdel-Khalek M, El-Baz M, Ibrahiem E-H. Predictors of prostate cancer on extended biopsy in patients with high-grade prostatic intraepithelial neoplasia: a multivariate analysis model. BJU Int 2004; 94: 528-33
De Nunzio C, Trucchi A, Miano R et al. The Number of Cores Positive for High Grade Prostatic Intraepithelial Neoplasia on Initial Biopsy is Associated With Prostate Cancer on Second Biopsy. J Urol 2009; 181: 1069-75
Barentsz JO, Richenberg J, Clements R et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746-57
Weinreb JC, Barentsz JO, Choyke PL et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol 2016; 69: 16-40
Giganti F, Moore CM. A critical comparison of techniques for MRI-targeted biopsy of the prostate. Transl Androl Urol 2017; 6: 432-43
Morote J, Celma A, Planas J et al. Prostate Magnetic Resonance Imaging, with or Without Magnetic Resonance Imaging-targeted Biopsy, and Systematic Biopsy for Detecting Prostate Cancer: A Cochrane Systematic Review and Meta-analysis. Eur Urol 2020;77:78-94: Are Targeted Prostate Biopsies Enough in Men with a Previous Negative Biopsy. Eur Urol 2020; 77: 138-9
Pierorazio PM, Walsh PW, Partin AW, Epstein JI. Prognostic Gleason grade grouping: Data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-60
Epstein JI, Zelefsky MJ, Sjoberg DD et al. A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. Eur Urol 2016; 69: 428-35
Epstein JI, Egevad L, Amin MB et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: Definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016; 40: 244-52
Ahmed HU, Hu Y, Carter T et al. Characterizing clinically significant prostate cancer using template prostate mapping biopsy. J Urol 2011; 186: 458-64
Ahmed HU, El-Shater Bosaily A, Brown LC et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389: 815-22
Thompson IM, Ankerst DP, Chi C et al. Assessing Prostate Cancer Risk: Results from the Prostate Cancer Prevention Trial. JNCI: Journal of the National Cancer Institute 2006; 98: 529-34
Nakai Y, Tanaka N, Miyake M, Hori S, Tatsumi Y, Morizawa Y et al. Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume. Res Rep Urol 2017; 9: 187-93
Girasole CR, Cookson MS, Putzi MJ et al. Significance of atypical and suspicious small acinar proliferations, and high grade prostatic intraepithelial neoplasia on prostate biopsy: implications for cancer detection and biopsy strategy. J Urol 2006; 175: 929-33
López JI. Prostate adenocarcinoma detected after high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. BJU Int 2007; 100: 1272-6
Singh PB, Nicholson CM, Ragavan N et al. Risk of prostate cancer after detection of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) on extended core needle biopsy: a UK hospital experience. BMC Urol 2009; 9: 3
He H, Osunkoya AO, Carver P et al. Expression of ERG protein, a prostate cancer specific marker, in high grade prostatic intraepithelial neoplasia (HGPIN): lack of utility to stratify cancer risks associated with HGPIN. BJU Int 2012; 110: E751-E5
Taneja SS, Morton R, Barnette G, Sieber P, Hancock ML. Steiner M· Prostate cancer diagnosis among men with isolated high-grade intraepithelial neoplasia enrolled onto a 3-year prospective phase III clinical trial of oral toremifene. J Clin Oncol 2013; 31: 523-9
Kim TS, Ko KJ, Shin SJ, et al. Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy. Korean J Urol 2015; 56: 796-2
Oderda M, Rosazza M, Agnello M et al. Natural history of widespread high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: should we rebiopsy them all. Scand J Urol 2021; 83: 3-8
Sirangam V, Rai BP, Abroaf A et al. Atypical small acinar proliferation and high grade prostatic intraepithelial neoplasia: should we be concerned? An observational cohort study with a minimum follow-up of 3 years. Curr Urol 2017; 10: 199-205
Nakai Y, Tanaka N, Miyake M et al. Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume. Res Rep Urol 2017; 9: 187-93
Wiener S, Haddock P, Cusano J et al. Incidence of clinically significant prostate cancer after a diagnosis of atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, or benign tissue. Urology 2017; 110: 161-5