PATTERNS OF HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA ASSOCIATEDWITH CLINICALLY AGGRESSIVE PROSTATE-CANCER

High-grade prostatic intraepithelial neoplasia (PIN) is the only widel y accepted precursor lesion for prostatic adenocarcinoma (PCa). Howeve r, the spread of established PCa within prostatic ducts may be indisti nguishable morphologically from high-grade PIN. By convention, all cyt ologically malignant cellular proliferations within prostatic ducts ha ve been lumped into a PIN category, although there have been recent at tempts by McNeal to develop reproducible criteria to separate high-gra de PIN from the spread of established PCa within prostatic ducts-intra ductal carcinoma (IDCa). Using McNeal's criteria for IDCa, we studied whole-mount sections from 252 patients with pT3NO PCa for the presence of IDCa and correlated the presence or absence of IDCa with Gleason s core, total tumor volume, surgical margin status, seminal vesicle invo lvement, and disease progression. Patients with IDCa had higher Gleaso n score and total tumor volume and were more likely to show seminal ve sicle involvement and disease progression than those patients without IDCa. In addition, IDCa was of independent prognostic significance. To tal tumor volume and surgical margin status had no independent prognos tic significance in this data set. Copyright (C) 1998 by W.B. Saunders Company.