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High-grade PIN and risk for clinically significant prostate cancer: an update

Posted Jan 14 2011 12:00am


Work by Bostwick and his colleagues (long before the development of Bostwick Laboratories) first showed a clear association between an initial diagnosis of high-grade prostatic intraepithelial neoplasia (HG-PIN) and subsequent risk for a diagnosis of prostate cancer.

What has been much less clear over the years has been the association between that initial diagnosis of HG-PIN and subsequent risk for clinically significant prostate cancer. A recently published paper by Godoy et al. may have provided us with some helpful insight into this association.

Godoy et al. set out to investigate the outcomes of serial delayed-interval biopsies (DIBx) in men initially diagnosed with isolated HG-PIN.

At their institution, since January 2000, it has been standard policy to offer serial DIBx every 3 years to all men initially diagnosed with isolated HG-PIN (based on a 12-core needle biopsy), regardless of any change in the patients’ PSA levels. The authors were therefore able to review their institutional database for information about men who had received at least one DIBx based on this follow-up strategy.

Here is what they were able to find:

  • 112 men initially diagnosed with HG-PIN had undergone a first DIBx and 47 had undergone a second DIBx at the last follow-up examination
  • The average (mean) times from initial diagnosis to first and second DIBx were 34.4 and 66.2 months, respectively.
  • 25/112 men (22.3 percent) were found to have prostate cancer at their first DIBx.
  • 11/47 men (23.4 percent) were found to have prostate cancer at their second DIBx.
  • PSA velocity was not predictive of cancer diagnosis during short-term follow-up.
  • In the men diagnosed with cancer

Now it would not be appropriate to conclude fr0m this study that 60 to 80 percent of men initially diagnosed with HG-PIN will go on to have clinically significant prostate cancer. This is too small a study and from just a single center to draw such a conclusion.

What can reasonably be concluded, however, is that men initially diagnosed with isolated HG-PIN do indeed have a continued and real risk of developing clinically significant prostate cancer during long-term follow-up, regardless of the changes in their serum PSA levels. Whether individual men are candidates for active surveillance or for active treatment of their disease would depend on a series of other parameters, such as their life expectancy, their co-morbidities, and their personal preferences.

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