The objective of the study was to investigate the relationship between histopathological features of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) and carcinoma risk in repeat prostate needle biopsies of 6 versus 12 cores.
METHODS
Of 114 isolated HGPIN cases were included; 64 with 6 (1st group) and 50 with 12 cores (2nd group). The
number of cores with HGPIN, laterality, structural PIN subtypes, prominent nucleolus, and nuclear
pleomorphism was examined in the first and follow-up biopsies. The relationship between the results of
follow-up biopsies and clinicopathological findings was evaluated statistically. Furthermore, a systematic
literature review was carried out.
RESULTS
Carcinoma was found in repeat biopsies in 15.6% of the cases in 6-core and 24% of cases with 12-core
biopsies (p=0.006). Carcinoma detection rate was significantly higher in cases with ?2 cores with HGPIN
than in cases with a single core of HGPIN (p=0.007). The rates of carcinoma and persistent HGPIN were
higher in multifocal and bilateral HGPIN cases, compared to unifocal, or multifocal but unilateral cases
(p=0.018). In both groups, prominent nuclear pleomorphism was significantly more common in cases
with carcinoma (p=0.023). The systematic literature review revealed 25.6% of carcinoma risk out of 5580
isolated HGPIN patients.
CONCLUSION
Carcinoma detection rate in repeat biopsies of 12-cores was significantly higher than cases with 6-core
biopsies. The HGPIN cases with ?2 cores, bilaterality, and presence of prominent nuclear pleomorphism
were found to be significant histopathological markers in predicting patients with carcinoma. Close follow-
up of high risk patients with repeat biopsies in addition to clinical parameters was recommended.