Diagnosis of high-grade prostatic intraepithelial neoplasia: The impact of the number of biopsy cores at initial sampling on cancer detection after a saturation re-biopsy

Marco Roscigno, Vincenzo Scattoni, Massimo Freschi, Marco Raber, Diego Angiolilli, Andrea Galosi, Vito Lacetera, Rodolfo Montironi, Giovanni Muzzonigro, Federico Deho, Luca Feroldil, Gianfranco Deiana, Daniela Chinaglia, Francesco Montorsi, Luigi Filippo Da Pozzo

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To evaluate factors that may predict prostate cancer (PCa) detection after initial diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) on 6-24 cores prostatic biopsies (PBx). Material and Methods: We retrospectively evaluated 193 patients submitted from 1998 to 2007 to prostate re-biopsy after initial HGPIN diagnosis in three urologic departments. HGPIN diagnosis was obtained on initial systematic PBx with 6 to 24 random cores. All patients were re-biopsied with a "saturation" PBx with 18-26 cores with a median time to re-biopsy of 12 months. All slides were reviewed by expert uro-pathologists. Results: Plurifocal HGPIN (pHGPIN) was found in 103 patients and monofocal HGPIN (mHGPIN) in 90. Seventy-two and 121 patients were submitted to > 12-core initial biopsy and ≤ 12-core, respectively. Overall PCa detection at re-biopsy was 28.4%. PSA (6.7 vs 8.5 ng/ml; p = 0.029) and age (64 vs 68 years; p = 0.005) were significantly higher in patients with PCa at re-biopsy. PCa detection was significantly higher in patients who underwent a ≤ 12-core initial PBx than in those with > 12-core (35.5% vs 16.8%; p = 0.03), and in patients with pHGPIN than in those with mHGPIN (34.9% vs 21%; p = 0.035). At multivariable analysis, PSA value (p = 0.007; HR:1.18), prostate volume (p = 0.01; HR:0.966), age (p <0.001; HR:1.15), pHGPIN (p = 0.003; HR:2.97) and ≤12-core initial biopsy (p = 0.012; HR:3.62) were independent predictors of PC detection. We further analysed the 2 groups of patients submitted to ≤ 12-core and > 12-core initial PBx. Plurifocal HGPIN and older age at biopsy were independent predictors in patients with ≤ 12-core initial PBx. On the contrary, in patients with > 12-core initial biopsy, higher PSA values and lower prostate volume were independent predictors of PC detection. Conclusions: PCa detection on saturation re-biopsy after initial diagnosis of HGPIN is significantly higher in patients submitted to ≤ 12-core than those submitted to > 12-core initial PBx. In patients with ≤ 12-core initial biopsy pHGPIN and older age were predictors of PCa detection at re-biopsy. In patients with > 12-core initial biopsy, higher PSA values and lower prostate volume was associated to an increased risk of PCa detection at re-biopsy.

Original languageEnglish
Pages (from-to)242-247
Number of pages6
JournalArchivio Italiano di Urologia e Andrologia
Volume82
Issue number4
Publication statusPublished - Dec 2010

Keywords

  • Biopsy
  • Prostate cancer
  • Prostatic intraepithelial neoplasia

ASJC Scopus subject areas

  • Urology

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