PROSTATIC INTRAEPITHELIAL NEOPLASIA DOES NOT APPEAR TO RAISE SERUM PROSTATE-SPECIFIC ANTIGEN CONCENTRATION

Objectives, Conflicting findings have been reported regarding the rela tionship between prostatic intraepithelial neoplasia (PIN) and serum p rostate-specific antigen (PSA) concentration. This study evaluates whe ther high-grade PIN significantly raises serum PSA concentration. Meth ods. We evaluated 194 totally embedded whole-mounted radical prostatec tomy specimens removed for clinically localized prostate cancer. No pa tient received preoperative therapy. In each specimen, the volume of h igh-grade PIN and carcinoma was calculated using the grid-counting met hod. Serum PSA concentration was determined prior to surgery. Cancer v olume, gland weight, Gleason score, extraprostatic extension, and PIN volume were then compared according to serum PSA concentration and PSA density. Results. Of the 194 patients, 170 (88%) had high-grade PIN-a ssociated cancer and 24 (12%) had PIN-free cancer within the specimen. PIN volume ranged from 0 to 8.1 cc (mean, 1.3) and cancer volume rang ed from 0 to 56.9 cc (mean, 9.1). In a subset of 93 patients with smal l cancers (less than 6.0 cc), PIN volume ranged from 0 to 6.1 (mean, 0 .83) and did not correlate with serum PSA concentration or PSA density (P = 0.80 and P = 0.69, respectively). In the entire study group, PIN volume did not correlate with PSA density (P = 0.17), but did correla te with serum PSA concentration (P = 0.005). Using multiple regression analysis, adjusting for cancer volume, gland weight, Gleason score, a nd extraprostatic extension, log PIN volume did not contribute to log serum PSA concentration (regression coefficient -0.108; P = 0.51) or l og PSA density (regression coefficient -0.104; P = 0.56) in small canc ers (less than 6.0 cc). In the entire study group, log PIN volume did not contribute to log serum PSA concentration (regression coefficient -0.182; P = 0.055) or log PSA density (regression coefficient -0.202; P = 0.56). Conclusions. Our data indicate that high-grade PIN does not significantly contribute to serum PSA concentration. We suggest that patients with elevated serum PSA concentration found to have high-grad e PIN on transrectal biopsy should not have their elevated serum PSA c oncentration attributed to high-grade PIN.