Epidemiology of high-grade prostatic intraepithelial neoplasia

This review summarizes published data dealing with the prevalence of high-g rade prostatic intraepithelial neoplasia (HGPIN) in a variety of prostate t issue samples. Additionally, we have attempted to document the relationship between HGPIN and the pathological parameters of prostate cancer in autops y and radical prostatectomy specimens. Studies reporting the prevalence of HGPIN in needle biopsies, transurethral resection specimens and radical pro statectomy specimens, and those documenting the lesion in postmortem settin gs are compared. We also summarize studies in which the distribution and/or extent of HGPIN was correlated with prostate cancer stage, grade and volum e. There is significant variation in the reported frequency of HGPIN, parti cularly in needle biopsy specimens, with a range of 0.8-23.9%. The factors responsible for these discrepancies include the population studied, the lim ited sample size that needle biopsies represent, diagnostic inconsistencies and, possibly, tissue preparation/staining variables. Because of the impor tant implications a diagnosis of HGPIN carries, there is a pressing need to achieve greater consistency in diagnosing and reporting the lesion. Better targeted educational efforts, including teaching courses, websites with il lustrations and the possibility of teleconsultations, are among possible me ans to attain this goal. Better documentation of the evolution of HGPIN to cancer through clinical follow-up is also recommended.