Here is a thought for you…So your PSA is high and you get a biopsy. The biopsy shows PIN. No cancer is seen. You are told, ” Uh Oh…you have a higher percentage of having prostate cancer if we do another biopsy.
So here is my thought. If you have the bad cancer or the very large volume prostate cancer, you’ll see that on your first biopsy. So, PIN, in away is a good thing. You don’t have prostate cancer and if you have it (not seen or detected on your biopsy) then it is either low volume or the good kind.
So why do another biopsy looking for cancer that most probably be low volume and a low Gleason’s score.
Why not just do a PSA and rectal exam in the patient with PIN and only rebiopsy those patients with a change for the worse?
PIN is indeed the new Active Surveillance. (Why go to the trouble of diagnosing something that you are going to watch anyway?)
Thoughts? Comment won’t you?
Prediction value of high-grade prostatic intraepithelial neoplasia for
prostate cancer on repeat biopsies
intraepithelial neoplasia in initial biopsy as an predictor for prostate cancer
has been extensively research, and the true relationship remnant is no clear
till now. The aim of this study is to evaluate prediction value of cancer on
repeat biopsy in patients with high-grade prostatic intraepithelial neoplasia,
using multivariate analysis.
prostatic intraepithelial neoplasia in initial needle biopsy were studies, in
the Fist Affiliated Hospital of Medical School of Xi’an Jiaotong University,
from January 2003 to March 2009. These samples were using immunostaining of p63
and 34βE12 and P504s, with a median follow-up of 525 (range, 7 to 1650) days,
and to researched the incidence of subsequent prostate cancer, and to predicted
the risk of prostate cancer in clinicopathological parameters of isolated
high-grade prostatic intraepithelial neoplasia on repeat biopsies by logistic
biopsies after diagnosis isolated high-grade prostatic intraepithelial neoplasia
in initial biopsy, of the rates of prostate cancer were 80% for micropapillary
and 75% for cribriform high-grade prostatic intraepithelial neoplasia (P
< 0.05), respectively. The positive cores of isolated high-grade prostatic
intraepithelial neoplasia was the important for the risk of prostate cancer
using Multifactor logistic regression analysis. The time range in 30 to 690 days
was stronger risk for prostate cancer detection after diagnosis isolated HGPIN
in initial biopsy. p63 and 34βE12 were disrupted positive expression, and P504S
was weak positive expression in the 61% isolated high-grade prostatic
repeat biopsy conferred a 26.3% risk of prostate cancer, and this risk level is
lower than the previously reported risk of 24% to 58%. The number of positive
cores and the histopathological pattern with high-grade prostatic
intraepithelial neoplasia on initial biopsy was significantly associated with
the risk of cancer.