Repeated prostate biopsies and the detection of cancer and high grade prostate intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP)
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Przemysław Adamczyk, Zbigniew Wolski

Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej CM w Bydgoszczy UMK w Toruniu

summary

Introduction.

Repeated prostate biopsies increase the detection of prostate cancer. However probability of premaligmant lesions (HGPIN, ASAP) detection is no clear still.

Objectives.

The aim of this study is evaluation of prostate cancer and precancerous lesions detection in repeated biopsies.

Materials and methods.

We evaluated 928 men with suspicious of prostate cancer on the basis of PSA elevation or/and digital rectal examination who were diagnosed by transrectal biopsies (TRUS). The indications for repeated extended biopsies were negative first biopsy in 78 patients with elevations of PSA level, detection of precancer lesions (HGPIN, ASAP), positive DRE. PSA levels were mean 19.4, median 8.9 ng/ml in all groups and mean 10.3, median 9 ng/ml in rebiopsy patients.

Results.

Prostate cancer was detected in 300 (32.3%) men, precancer lesions in 135 (14.5%), (68-7.3% HGPIN) (50-5.3%, ASAP), (HGPIN and ASAP 17/1.8%), Lowe Grade PIN in 22 (12.3%), BPH in 369 (39.7%), inflamation in 99 (10.6%). We observed HGPIN in 8%, ASAP in 4% with cancer patients. PSA levels were mean 34.8, median 12 ng/ml in cancer patients. PSA levels were median 9.4 ng/ml for patients with HGPIN and median 9.8 ng/ml for patients with ASAP and there was no statistical difference. 11 (14.1%) patients had prostate cancer, ASAP – 15 (19.2%), HGPIN – 12 (15.4%), BPH – 25 (32%), inflammation – 10 (12.2%), LGPIN – 4 (5.1%) in rebiopsies. Repeated prostate biopsies increased the detection of cancer from 32.3 to 33.5% (more than 1.2%) and precancer lesions from 14.4 to 17.1% (more than 2.7%). Prostate cancer was

detected in 4 (26%) patients among 15 with ASAP, in 4 (30%) among 12 with HGPIN in primary biopsy. None of the patients with LGPIN had cancer in rebiopsy. None of the patients with BPH, HGPIN, ASAP and associated inflammation or single inflammation had prostate cancer in rebiopsy. High Gleason score dominated in patients with previously observed HGPIN in comparison to ASAP.

Conclusions.

1. Repeated biopsies increased the detection of cancer and premalignant lesions only of 1.2% and 2.7%. 2. Prostate cancer was detected more frequently in patients with HGPIN than ASAP. 3. Inflammation and LGPIN probably have no influence on the detection of prostate cancer.