REPEAT BIOPSY STRATEGY IN MEN WITH ISOLATED PROSTATIC INTRAEPITHELIALNEOPLASIA ON PROSTATE NEEDLE-BIOPSY

Purpose: Isolated high grade prostatic intraepithelial neoplasia on ne edle biopsy of the prostate is a strong predictor of malignancy on rep eat biopsy. However, the optimal repeat biopsy technique for these pat ients has not been defined. Materials and Methods: We reviewed the rec ords of 66 men in whom isolated prostatic intraepithelial neoplasia wa s found on needle biopsy of the prostate. We evaluated the side and/or quadrant and grade of prostatic intraepithelial neoplasia on initial biopsy, and compared the findings to the location of cancer on repeat biopsy. Results: Of 66 men 31 (47%) had cancer on repeat biopsy, with disease on the same side of the prostate as prostatic intraepithelial neoplasia in 20 (64%). The quadrant locations of prostatic intraepithe lial neoplasia and cancer matched in 6 of 12 cases (50%). Low and high grade prostatic intraepithelial neoplasia predicted the side of cance r on repeat biopsy in 3 of 5 (60%) and 17 of 26 (65%) cases, respectiv ely. Conclusions: Directing repeat biopsy solely to the side with pros tatic intraepithelial neoplasia will miss cancer in approximately 35% of cases. The optimal repeat biopsy technique for patients with high g rade prostatic intraepithelial neoplasia should include systematic bio psy of the prostate.