High-grade prostatic intraepithelial neoplasia

Abstract

High-grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic carcinoma. The only method of detection is biopsy; prostatic intraepithelial neoplasia (PIN) does not significantly elevate serum prostate-specific antigen concentration and cannot be detected by ultra-sonography. The incidence of PIN in prostate biopsies averages 9% (range, 4%-16%), representing 115,000 new cases of PIN diagnosed each year in United States. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeated biopsy for concurrent or subsequent invasive carcinoma. Carcinoma will develop in most patients with PIN within 10 years. PIN is associated with progressive abnormalities of phenotype and genotype that are intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. Androgen deprivation therapy decreases the prevalence and extent of PIN, suggesting that this form of treatment may play a role in chemoprevention.

Figure 1

High-grade prostatic intraepithelial neoplasia, tufting pattern (hematoxylin & eosin, × 400).

Figure 2

High-grade prostatic intraepithelial neoplasia, micropapillary pattern (hematoxylin & eosin, × 400).)

Figure 3

High-grade prostatic intraepithelial neoplasia, cribiform pattern (hematoxylin & eosin, × 200).)

Figure 4

High-grade prostatic intraepithelial neoplasia, flat pattern (hematoxylin & eosin, × 200).)

Figure 5

Historical biopsy approaches (left) could easily miss invasive cancer (gray) because of undersampling. In modern biopsy approaches (right), with multiple cores being taken, it is unlikely that a concomitant carcinoma in the face of PIN (yellow) will be missed. PIN, prosatic intraepithelial neoplasia.