PROSTATIC INTRAEPITHELIAL NEOPLASIA - INFLUENCE OF CLINICAL AND PATHOLOGICAL DATA ON THE DETECTION OF PROSTATE-CANCER

Purpose: We attempted to characterize patients diagnosed with prostati c intraepithelial neoplasia without concurrent cancer on biopsy who ha d prostate cancer on subsequent biopsy. Materials and Methods: The rec ords of 93 patients with low and high grade prostatic intraepithelial neoplasia without concurrent cancer on initial biopsy were analyzed. T he relationships among prostatic intraepithelial neoplasia grades, pat ient age, digital rectal examination, serum prostate specific antigen (PSA), transrectal ultrasound appearance and final pathological result s were investigated. Results: Subsequent carcinoma was found on repeat biopsy in 13.3% of patients with low grade and 47.9% with high grade prostatic intraepithelial neoplasia (p <0.001). In the former group di gital rectal examination, patient age, serum PSA and transrectal ultra sound were not predictive of cancer. Transrectal ultrasound appearance , digital rectal examination and serum PSA were statistically differen t between high grade prostatic intraepithelial neoplasia with and with out subsequent cancer (p <0.001, p = 0.008 and p = 0.016, respectively , univariate analysis). On multivariate analysis of patients with high grade prostatic intraepithelial neoplasia only digital rectal examina tion and PSA were predictive of subsequent carcinoma. Conclusions: Hig h grade prostatic intraepithelial neoplasia is a strong predictor of s ubsequent cancer, especially in men with abnormal digital rectal exami nation and elevated serum PSA. Patients with high grade prostatic intr aepithelial neoplasia should undergo repeat biopsy to exclude cancer. Further investigations are needed to optimize the treatment of patient s with low grade prostatic intraepithelial neoplasia.