No abstract available.
Prostatectomy* ; Prostatic Intraepithelial Neoplasia*

No abstract available.
Prostatectomy* ; Prostatic Intraepithelial Neoplasia*

Humans ; Male ; Prostate ; pathology ; Prostatic Intraepithelial Neoplasia ; classification ; diagnosis ; pathology

Prostate intraepithelial neoplasia (PIN) is a putative premalignant change in the human prostate, which is an intraluminal proliferation of the secretory cells of the prostatic duct-acinar system that is enveloped by a basal cell layer and displays a spectrum of dysplastic cytologic features ranging from minimal atypia (low grade PIN) to those which are ultimately indistinguishable from carcinoma cells (high grade PIN). To evaluate the clinical significance of the PIN in prostatic tumor and BPH, we reviewed the serum prostate specific antigen (PSA), prostate specific antigen density (PSAD), and pathologic findings in the specimen of 21 BPH and 11 Prostate cancers, which were pathologically confirmed. The distributions of PIN are 7/21 (33%) in BPH and 8/ 11 (73%) in prostatic ca (P<0.05). The mean value (+/-SD) of PSA and PSAD in BPH patient were 8.42+/-5.57 ng/ml, 0.16+/-0.09 for PIN(-), 10.13+/-5.97 ng/ml, 0.17+/-0.09 for PIN(+), and in prostatic cancer patient were 60.53+/-1.83 ng/ml, 1.42+/-0.25 for PIN(-), 54.15+/-34.61 ng/ml, 1.28+/-0.84 for PIN(+), respectively. The mean value (+/-SD) of PSA & PSAD according to histologic types of BPH were 9.04+/-3.88 ng/ml, 0.17+/-0.06 for glandular type, 5. 57+/-1.31 ng/ml, 0.10+/-0.03 for stromal type, and 11.18+/-8.93 ng/ml, 0.19+/-0.13 for mixed type. The distributions of PIN according to histologic types of BPH were 30% (3/10) for glandular type, 40% (2/5) for stromal type, and 33% (2/6) for mixed type. All 7 PIN(+) BPH were low grade, while, of the 8 PIN(+) prostatic Ca, 1 was low grade and 7 were high grade. From these results, the frequent of PIN was higher in prostatic cancer than BPH (P<0.05). PIN had no significant influence on PSA elevation in prostatic cancer and BPH. There was no correction between PSA, PSAD and histologic types of BPH (P>0.05). There was no significant difference in the distribution of PIN according to histologic types of BPH. And high grade PIN was observed only in prostatic cancer. Therefore, if high grade PIN is observed in pathologic specimens, undetected prostatic cancer should be found.
Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Intraepithelial Neoplasia* ; Prostatic Neoplasms*

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.
Biopsy* ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms* ; Ultrasonography

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.
Biopsy* ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms* ; Ultrasonography

BACKGROUND: We developed a new processing method for extended prostate needle biopsy, and evaluated diagnostic utility of routine immunohistochemistry in 1,000 consecutive unselected cases of transrectal ultrasound-guided systematic prostate biopsy. METHODS: Four to five biopsy cores were embedded in one paraffin block. All the biopsy cores were immunohistochemically stained with basal cell markers. RESULTS: The new sample processing method was technically perfect for making a diagnosis from extended prostate needle biopsy. Among 1,000 cases, there were 323 cases (32.3%) of adenocarcinoma, 5 cases of other malignant tumors, 9 cases of high-grade prostatic intraepithelial neoplasia without a carcinoma, and only 8 cases of atypical small acinar proliferation. Among the 323 cases of adenocarcinoma, there were 38 cases (11.8%) of microcarcinomas <0.1 cm and 101 cases (31.3%) of small adenocarcinomas <0.3 cm in length. In the needle biopsy specimens, 59 cases (18.3%) were classified as clinically insignificant carcinomas. Among them, 37 cases underwent radical prostatectomy, which turned out to be clinically significant carcinomas in 24 cases (64.9%). CONCLUSIONS: Routinely performed immunohistochemistry combined with the new sample processing method is very effective for detecting microscopic carcinoma foci as well as differentiating carcinoma from benign conditions mimicking cancer.
Adenocarcinoma ; Biopsy* ; Biopsy, Needle ; Diagnosis ; Immunohistochemistry* ; Paraffin ; Prostate* ; Prostatectomy ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms

PURPOSE: We investigated the predictive factors in patient with prostate cancer diagnosed by repeat prostate biopsy, where initial prostate biopsy results were negative for malignancy. MATERIALS AND METHODS: Between March 2000 and June 2007, 1280 men with suspected prostatic cancer underwent transrectal ultrasound guided needle biopsy of the prostate, with 148 (11.6%) diagnosed as having prostate cancer. Of 1132 men whose biopsy results were negative for malignancy, 655 whose prostate specific antigen (PSA) was elevated persistently underwent second biopsy, and 462 underwent third biopsy as the same course. Twelve core biopsies were performed in the majority of patients. To determine predictive factors, we evaluated prostate volume, serum PSA, percent free PSA, PSA density (PSAD), transition zone PSAD, PSA velocity (PSAV) and pathological report of previous biopsy between the men with cancer detection and the men with negative biopsy in second and third biopsy. RESULTS: Overall cancer detection rate was 16.3% (208/1280). From the first, second and third biopsies, the cancer detection rate were 11.6, 5.5 and 5.2%, respectively. There were significant differences in percent free PSA, transition zone PSAD, PSAV between cancer and negative biopsy groups after serial repeat biopsies (p<0.05). Multivariate logistic regression analysis revealed that the transition zone PSAD, PSAV, and presence of either atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in initial biopsy specimen were significant predictors for prostate cancer diagnosed by repeat biopsy. CONCLUSIONS: Of the men with negative results on the first biopsy, 60 (5.4%) were diagnosed prostate cancer after serial biopsies. The transition zone PSAD, PSAV, and presence of either ASAP or HGPIN in initial biopsy specimen are predictable factors for prostate cancer detection on repeat biopsy.
Biopsy ; Biopsy, Needle ; Humans ; Logistic Models ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms

High-grade prostatic intraepithelial neoplasia (HGPIN) has been established as a precursor to prostatic adenocarcinoma. HGPIN shares many morphological, genetic, and molecular signatures with prostate cancer. Its predictive value for the development of future adenocarcinoma during the prostate-specific antigen screening era has decreased, mostly owing to the increase in prostate biopsy cores. Nevertheless, a literature review supports that large-volume HGPIN and multiple cores of involvement at the initial biopsy should prompt a repeat biopsy of the prostate within 1 year. No treatment is recommended for HGPIN to slow its progression to cancer.
Adenocarcinoma ; Biopsy ; Mass Screening ; Prostate ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms

Objective: To assess the rates of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) detected in prostate biopsy in China and the risk of PCa found in subsequent repeat biopsy. METHODS: A total of 2,456 patients underwent TRUS-guided prostate biopsy with the samples of ASAP and/or HGPIN tissues in our hospital at least twice between July 2014 and June 2019. We analyzed the findings of digital rectal examination, prostate volumes, PSA levels, and the results of prostate biopsies. RESULTS: Initial prostate biopsies revealed 737 cases of PCa (30.0%), 215 cases of ASAP (8.8%), 98 cases of HGPIN (4.0%), and 18 cases of ASAP+HGPIN (0.7%). Totally, 313 of the patients met the inclusion criteria and included in this study. Of the 215 cases of ASAP confirmed in the first biopsy, 72 and 25 were diagnosed with PCa in the second and third biopsies, respectively, 83 with Gleason score (GS) 6, 14 with GS7, 57 with T1c and 40 with T2a tumors. Of the 98 cases of HGPIN confirmed in the first biopsy, 1 was diagnosed with PCa in the second and another 1 in the third biopsy, both with GS6 and T1c tumors. Of the 18 cases of ASAP+HGPIN confirmed in the first biopsy, 7 and 3 were diagnosed with PCa in the second and third biopsies, respectively, 7 with GS6, 3 with GS7, 6 with T1c and 4 with T2a tumors. CONCLUSIONS ASAP is a significant risk factor for PCa and repeat prostate biopsy should be performed for patients diagnosed with ASAP in the first biopsy. Whether repeat biopsy is necessary for those diagnosed with HGPIN depends on other related clinical parameters./.
Biopsy ; Cell Proliferation ; China/epidemiology* ; Humans ; Male ; Prostate ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms