The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia
Morote Robles, Juan (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Schwartzmann, Ivan (Hospital Universitari Vall d'Hebron)
Celma, Ana (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Roche, Sarai (Hospital Universitari Vall d'Hebron)
de Torres, Inés (Universitat Autònoma de Barcelona)
Mast, Richard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Semidey Raven, María Eugenia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Regis, Lucas (Hospital Universitari Vall d'Hebron)
Santamaría, Anna (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Planas, Jacques (Hospital Universitari Vall d'Hebron)
Trilla Herrera, Enrique (Hospital Universitari Vall d'Hebron)

Data:	2022
Resum:	Objective: To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies. Patients and Methods: A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and who underwent repeat biopsy within 1 to 3 years, was analysed. Pre-repeat biopsy mpMRI and guided biopsies to suspicious lesions (Prostate Imaging - Reporting and Data System [PI-RADS] ≥3) and/or and systematic biopsies were performed. Persistent prostate cancer (PCa) suspicion, defined as sustained serum prostatespecific antigen level >4 ng/mL and/or abnormal digital rectal examination, was present in 248 men (84. 6%), and was absent in 45 men (15. 4%). A control group of 190 men who had no previous HGPIN, atypical small acinar proliferation or HGPIN with atypia who were scheduled to undergo repeat biopsy due to persistent PCa suspicion were also analysed. csPCa was defined as tumours of Grade Group ≥2. Results: In the subset of 45 men with isolated HGPIN, in whom PCa suspicion disappeared, only one csPCa (2. 2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34. 7% of men with persistent PCa suspicion and previous HGPIN, and in 28. 4% of those without previous HGPIN (P =0. 180). iPCa was detected in 12. 1% and 6. 3%, respectively (P =0. 039). Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN: odds ratio (OR) 1. 369 (95% confidence interval [CI] 0. 894-2. 095; P =0. 149); however, previous HGPIN increased the risk of iPCa detection: OR 2. 043 (95% CI 1. 016-4. 109; P =0. 006). Conclusion: The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	High-grade intraepithelial neoplasia ; Clinically significant prostate cancer ; Insignificant prostate cancer ; Multiparametric MRI ; Repeat prostate biopsy
Publicat a:	BJU International, Vol. 129 (2022), p. 627-633, ISSN 1464-410X

DOI: 10.1111/bju.15568
PMID: 34375498

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