The predictive value for prostate cancer of lesions that raise suspicion of concomitant carcinoma - An evaluation from a randomized, population-basedstudy of screening for prostate cancer

Background, Suspicion of prostate carcinoma may persist after an initial ne gative biopsy result, and repeated biopsy is suggested. The authors assesse d whether diagnostic follow-up of men with an initial diagnosis of isolated , high-grade prostatic intraepithelial neoplasia (HPIN) and a prostate biop sy suspicious for malignancy (PBSM) is needed. Methods. The frequency of isolated HPIN and PBSM was determined in 4057 par ticipants of a population-based screening study who underwent systematic se xtant transrectal biopsy. The predictive value for prostate carcinoma of HP IN and PBSM was determined by performing repeated biopsies at 6-week interv al. The additional predictive value for malignant disease within a screened population was assessed by performing repeated biopsies at a 1-year interv al in 462 consecutively recruited men with an initial benign biopsy result. Participants were subjected to a second screening at a 4-year interval. Th e biopsy and radical prostatectomy tumor features were determined. Results, Isolated HPIN and PBSM were diagnosed in 0.8% and 2.6% of biopsied men, respectively. The detection rates on repeated biopsy were 10.0% (3 of 30 men) for isolated HPIN, 38.7% (36 of 93 men) for PBSM, and 11.0% (51 of 462 men) for those with initial benign biopsy results. Except for two men (one with PBSM and one with HPIN), all others remained free of prostate car cinoma at their second screening. Features of the tumors that were detected after PBSM were comparable to those that were detected on initial biopsy, whereas the few tumors that were diagnosed after HPIN had highly favorable features. Conclusions. Compared with men who have PBSM, men with isolated HPIN on ini tial biopsy are at no greater risk of being diagnosed with prostate carcino ma than if their initial biopsies were assessed as benign only. Moreover, t he features of tumors that are diagnosed after an evaluation of HPIN warran t no early, extensive diagnostic follow-up. Cancer 2001;92:524-34. (C) 2001 American Cancer Society.