Evaluation of prostate needle biopsies in a population-based screening study - The impact of borderline lesions

BACKGROUND. The finding of isolated high grade prostatic intraepithelial ne oplasia (PIN) or borderline lesions (lesions suspicious for malignancy) in prostate needle biopsies warrants repeat biopsies. The reported frequency o f these lesions in prostate needle biopsies varies considerably. The author s evaluated the frequency and clinical impact of high grade PIN and borderl ine lesions in sextant prostate needle biopsies obtained from screened part icipants in the European Randomized study of Screening for Prostate Cancer (ERSPC). METHODS. A total of 8763 participants in the Rotterdam section of the ERSPC ages 55-75 years were screened systematically for prostate carcinoma. Syst ematic sextant prostate needle biopsies were prompted by an abnormal digita l rectal examination and/or abnormal transrectal ultrasonography findings a t serum prostate specific antigen (PSA) levers greater than or equal to 1.0 ng/mL or a PSA level greater than or equal to 4.0 ng/mL. Repeat biopsies w ere obtained within 6 months after initial biopsy. RESULTS. Of 1824 biopsied men, 384 (21.1%) were found to have prostate carc inoma on initial biopsy. Twelve participants (0.7%) had isolated high grade PIN and 43 (2.4%) had borderline lesions. Repeat biopsies yielded no carci noma in 7 participants with initial high grade PIN and 15 tumors (38.5%) in 39 participants with borderline lesions. CONCLUSIONS. In prostate needle biopsies obtained from a screened populatio n, indications for repeat biopsy such as high grade PIN and borderline lesi ons do not represent large diagnostic subsets. Borderline lesions comprise the most important indication for a repeat biopsy. The low frequency of equ ivocal biopsy diagnoses in the current study supports the clinical applicab ility of sextant needle biopsies in population-based screening for prostate carcinoma. Cancer 1999;85:145-52. (C) 1999 American Cancer Society.