Diagnosis of isolated high-grade prostatic intra-epithelial neoplasia: Proposal of a nomogram for the prediction of cancer detection at saturation re-biopsy

Marco Roscigno, Vincenzo Scattoni, Massimo Freschi, Firas Abdollah, Carmen Maccagnano, Andrea Galosi, Vito Lacetera, Rodolfo Montironi, Giovanni Muzzonigro, Federico Deho, Gianfranco Deiana, Domenico Belussi, Daniela Chinaglia, Francesco Montorsi, Luigi F. Da Pozzo

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: • To evaluate factors that may predict prostate cancer (PCa) detection after the initial diagnosis of high-grade prostatic intra-epithelial neoplasia (HGPIN) on prostate biopsy (PBx) with six to 24 random cores. PATIENTS AND METHODS: • We retrospectively evaluated 262 patients submitted from 1998 to 2007 to prostate re-biopsy (rPBx) after an initial HGPIN diagnosis in tertiary academic centres. • HGPIN diagnosis was obtained on initial systematic PBx with six to 24 random cores. • All patients were re-biopsied with a ' saturation ' rPBx with 20-26 cores, with a median time to rPBx of 12 months. • All slides were reviewed by expert uropathologists. RESULTS: • Plurifocal HGPIN (pHGPIN) was found in 115 patients and monofocal HGPIN (mHGPIN) was found in 147 patients. • In total, 108 and 154 patients, respectively, were submitted to > 12-core initial PBx and ≤ 12-core initial PBx. • Overall PCa detection at rPBx was 31.7%. PSA level (7.7 vs 6.6 ng/mL; P = 0.031) and age (68 vs 64 years; P = 0.001) were significantly higher in patients with PCa at rPBx. • PCa detection was significantly higher in patients with a ≤ 12-core initial PBx than in those with a > 12-core initial PBx (37.6% vs 23.1%; P = 0.01), as well as in patients with pHGPIN than in those with mHGPIN (40% vs 25.1%; P = 0.013). • At multivariable analysis, PSA level ( P = 0.041; hazards ratio, HR, 1.08), age ( P <0.001; HR, 1.09), pHGPIN ( P = 0.031; HR, 1.97) and ≤ 12-core initial PBx ( P = 0.012; HR, 1.95) were independent predictors of PCa detection. • A nomogram including these four variables achieved 72% accuracy for predicting PCa detection after an initial HGPIN diagnosis. CONCLUSIONS: • PCa detection on saturation rPBx after an initial diagnosis of HGPIN is significantly higher in patients with a ≤ 12-core initial PBx than those with a > 12-core initial PBx and in patients with pHGPIN than in those with mHGPIN. • We developed a simple prognostic tool for the prediction of PCa detection in patients with initial HGPIN diagnosis who were undergoing saturation rPBx.

Original languageEnglish
Pages (from-to)1329-1334
Number of pages6
JournalBJU International
Volume109
Issue number9
DOIs
Publication statusPublished - May 2012

Keywords

  • High-grade intraprostatic neoplasia
  • Nomograms
  • Saturation biopsy

ASJC Scopus subject areas

  • Urology

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