Significance of high-grade prostatic intraepithelial neoplasia in needle biopsy specimens

Objectives. To examine the significance of high-grade prostatic intraepithe lial neoplasia (HGPIN) in biopsy specimens. Methods. We performed sextant biopsies on a series of 83 cystoprostatectomy specimens removed for bladder cancer. For each case the number of foci and volume of both HGPIN and prostate cancer were assessed in the prostatectom y specimens and compared with the number of biopsy specimens involved by HG PIN. Results. We identified HGPIN in 82 (99%) of 83 prostatic glands, whereas pr ostate cancer was found in 41 cases (49%). Corresponding sextant biopsies h arbored both HGPIN and prostate cancer in 6 cases (7%), whereas only HGPIN was diagnosed in 29 sextant biopsies (35%). There was a positive correlatio n between the number of biopsy specimens containing HGPIN and the volume an d multifocality of HGPIN in the corresponding prostatic glands. Prostates w ith HGPIN on sextant biopsy contained prostate cancer significantly more of ten when compared to cases with no HGPIN on sextant biopsy. Frequency of co ncurrent prostate cancer was higher in cases with two or more biopsy specim ens containing HGPIN than in cases with only one such biopsy specimen, but case numbers of these categories were too small to render this difference s tatistically significant. Conclusions. The presence of HGPIN in sextant biopsies is a significant pre dictor of concurrent prostate cancer. Multifocality of HGPIN is a useful pa rameter in assessing the extent of HGPIN in the corresponding prostates. It s value in predicting a significantly increased risk of concurrent prostate cancer needs to be further investigated in larger case studies. UROLOGY 57 : 486-490, 2001. (C) 2001, Elsevier Science Inc.