Non-Cancerous Prostate Biopsy Results:
PIN: Prostatic Intraepithelial Neoplasm—-Most likely no big deal. Think of the actual individual prostate gland cell…the nucleus isn’t right. For a cell to be “cancerous” it has to invade tissue. In PIN there is no invasion, just a funny looking nucleus. In my practice, and I must have about two hundred patients I follow with PIN, it seldom progresses. Think of it this way….If a patient has the actual diagnosis of prostate cancer and the parameters are favorable…the surveillance is an option and the likelihood is that the patients cancer won’t progress. Well then, PIN is way better situation than that…”gently keep your eye on it.”
PIN vs. Suspicious– I think suspicious trumps PIN. The studies referenced show a higher chance of a positive subsequent biopsy than I have noted in my practice.
In both cases it ain’t cancer and that’s good on a couple of fronts.
- Bad prostate cancers, the high Gleason Scores (8-10) are easy for the pathologist to call. So if your biopsy comes back equivocal (PIN or suspicious) then you know it’s not the bad kind and if it were cancer then you know it would most probably be he good kind or low Gleason’s (6).
- PIN and a suspicious core on a biopsy means that they patient needs to be followed more closely and the likelihood of having another biopsy to confirm the absence of cancer is greater. The period of time between follow ups also may be closer.
- Although the chances are greater that one day a PIN or Suspicious will end up cancer, not all do.
- I view PIN or Suspicious as good news (better than being told you have prostate cancer ) and I recommend maybe another biopsy once in six months to confirm, and then twice a year PSA’s and another biopsy only if there is a change in the rectal exam or a PSA velocity change.
- If the pathologist isn’t sure the biopsy specimen has cancer and only a few of the cores are suspicious, then if one day on another biopsy shows cancer….it will be probably be low volume, probably low Gleason’s….that’s favorable and that’s a good thing.
- I mention in my book when reflecting about how I felt the night before I got my results that I was not worried about the favorable type prostate cancer…I did not want a result with the bad or unfavorable parameters…that is what really worried me.
- If you are here because of a suspicious or PIN biopsy, I hope the above has somewhat eased your “potential” fears but also make you diligent and follow the recommendations of your urologist.
How is golf and prostate cancer alike? A slice will listen to you, a hook won’t do a damn thing you say. The unfavorable prostate cancer is a lot like a hook. So…that’s the bright side of PIN and Suspicious/Atypia.
Suspicious carries more weight than PIN however both findings require a bit closer follow-up.