Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy
Pg. Borboroglu et al., Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy, J UROL, 166(3), 2001, pp. 866-870
Purpose: Isolated high grade prostatic intraepithelial neoplasia and/or aty
pical small acinar proliferation on prostate biopsy increases the risk of i
dentifying cancer on repeat biopsy. We report the results of repeat prostat
e biopsy for high grade prostatic intraepithelial neoplasia and/or atypical
small acinar proliferation, and propose an optimal repeat biopsy strategy.
Materials and Methods: Of 1,391 men who underwent standard systematic sexta
nt biopsy of the prostate 137 (9.8%) had isolated high grade prostatic intr
aepithelial neoplasia or atypical small acinar proliferation, including 100
who underwent repeat prostate biopsy within 12 months of the initial biops
y.
Results: Adenocarcinoma was detected in 47 of the 100 patients who underwen
t repeat biopsy. The initial biopsy site of high grade prostatic intraepith
elial neoplasia and/or atypical small acinar proliferation matched the sext
ant location of cancer on repeat biopsy in 22 cases (47%). Repeat biopsy di
rected only to the high grade prostatic intraepithelial neoplasia and/or at
ypical small acinar proliferation site on initial biopsy would have missed
53% of cancer cases. In 12 of the 47 men (26%) cancer was limited to the si
de of the prostate contralateral to the side of high grade prostatic intrae
pithelial neoplasia and/or atypical small acinar proliferation. Of the 31 p
atients with cancer in whom the transition zone was sampled cancer was limi
ted to the transition zone in 4 (13%) and evident at other biopsy sites in
13 (42%). The only significant predictor of positive repeat biopsy was mean
prostate specific antigen velocity plus or minus standard error (1.37 +/-
1.4 versus 0.52 +/- 0.8 ng./ml. per year, p <0.001).
Conclusions: Patients with isolated high grade prostatic intraepithelial ne
oplasia and/or atypical small acinar proliferation on prostate biopsy are a
t 47% risk for cancer on repeat biopsy. The optimal repeat biopsy strategy
in this setting should include bilateral biopsies of the standard sextant l
ocations. We also strongly recommend that transition zone sampling should b
e considered.