Abstract
Introduction: High-grade prostatic intraepithelial neoplasia (HGPIN) is generally accepted to be a precursor lesion of prostate cancer. The likely outcome of isolated low-grade PIN (LGPIN) lesions in prostate biopsies remains unclear. A follow-up study of 106 patients with LGPIN- and HGPIN lesions was performed.
Materials and methods: In a 2-y period, 207 men were diagnosed with isolated PIN on standard systematic sextant biopsy of the prostate. In total, 104 patients had LGPIN and 103 had HGPIN. No patients had ever received androgen deprivation therapy, chemotherapy or radiation therapy. In all, 106 patients who underwent repeat second or third sextant biopsies were analysed in the study; 30% of these patients received a selenium–vitamin E supplement for at least 6 months.
Results: In total, 43 had LGPIN and 63 HGPIN on the first biopsy. The mean age was 63.5 y (range 46–77) in the LGPIN group and 64.9 y in the HGPIN group. The mean total PSA was 6.96 ng/ml (range 0.59–34.13) in the LGPIN group and 8.44 ng/ml (range 0.59–35.3) in the HGPIN group. In the LGPIN group, 30% of the patients had cancer in at least one of the repeat biopsy cores. In the HGPIN group, 27% had cancer in at least one of the repeat biopsy cores. The mean total PSA of patients who had cancer in repeat biopsies with LGPIN was 7.84 ng/ml (range 2.92–34.13). The mean total PSA of the patients who had cancer in repeat biopsy in the HGPIN was 6.73 ng/ml (range 0.56–25). There was no significant difference in PSA and pathological stage between those patients who did and those who did not receive selenium–vitamin E supplements.
Conclusions: These data are intriguing since the risk of finding prostate carcinoma on repeat sextant biopsy in the LGPIN group is 30%. This is higher than commonly reported. The importance of recognising and re-biopsying HGPIN was confirmed. If chemoprevention could be shown to be effective, it might be beneficial not only in HGPIN but also in LGPIN. The possible activity of chemopreventive agents and their combination with iso-flavonoids needs further investigation.
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References
Bostwick DG . Prostatic intraepithelial neoplasia is a risk factor for cancer. Semin Urol Oncol 1999; 17: 187–198.
Kamat AM, Lamm DL . Chemoprevention of urological cancer. J Urol 1999; 161: 1748–1760.
Bostwick DG, Neumann R, Qian J, Cheng L . Reversibility of prostatic intraepithelial neoplasia: implications for chemoprevention. Eur Urol 1999; 35: 492–495.
Sakr WA . Prostatic intraepithelial neoplasia: a marker for high-risk groups and a potential target for chemoprevention. Eur Urol 1999; 35: 474–478.
Vis AN, Van der Kwast TH . Prostatic intraepithelial neoplasia and putative precursor lesions of prostate cancer: a clinical perspective. BJU Int 2001; 88: 147–157.
Lipski B, Garcia R, Brawer M . Prostatic intraepithelial neoplasia: significance and management. Semin Urol Oncol 1996; 14: 149–155.
Mc Neal JE, Bostwick DG . Intraductal dysplasia: a premalignant lesion of the prostate. Hum Pathol 1986; 17: 64–71.
Zlotta A, Schulman C . Clinical evolution of prostatic intraepithelial neoplasia. Eur Urol 1999; 35: 498–503.
Swinnen JV et al. Overexpression of fatty acid synthase is an early and common event in the development of prostate cancer. Int J Cancer 2002; 98: 19–22.
Coogan C, Bostwick D, Bloom K, Gould V . Glycoprotein A-80 in the human prostate: immunolocalization in prostatic intrepithelial neoplasia, carcinoma, radiation failure, and after neoadjuvant hormonal therapy. Urology 2003; 61: 248–252.
Epstein JE, Potter SR . The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. J Urol 2001; 166: 402–410.
Langer JE, Rovner ES, Coleman BG . Strategy for repeat biopsy of patients with prostatic with prostatic intraepithelial neoplasia detected by prostate needle biopsies. J Urol 1996; 154: 1791–1794.
Shepherd D et al. Repeat biopsy strategy in men with isolated prostatic intraepithelial neoplasia on prostate needle biopsy. J Urol 1996; 156: 460–463.
Kamoi K, Troncoso P, Babaian J . Strategy for repeat biopsy in patients with high grade prostatic intraepithelial neoplasia. J Urol 2000; 163: 819–823.
Montironi R, Mazzucchelli R, Scarpelli M . Precancerous lesions and conditions of the prostate. Ann NY Acad Sci 2002; 963: 169–184.
Boyle W, Maisonneuve P, Napalkov P . Geographical and temporal patterns of incidence and mortality from prostate cancer. Urology 1995; 46(Suppl 3A): 47–55.
Parker S, Tong T, Bolden S, Wingo P . Cancer statistics. Ca Cancer J Clin 1997; 47: 5–27.
Parkin D, Muir C . Cancer incidence in five continents: comparability and quality data. IARC Sci Publ 1992; 120: 45–173.
Muir C, Nectoux J, Staszewski J . The epidemiology of prostatic cancer: geographical distribution and time-trends. Acta Oncol 1991; 30: 133–140.
Stellman S, Wang Q . Cancer mortality in Chinese migrants to New York City; comparison with Chines in Tianjin and with United States born whites. Cancer 1994; 73: 1270–1275.
Shimizu H et al. Cancers of the prostate and the breast among Japanese and white immigrants in Los Angeles County. Br J Cancer 1991; 63: 963–966.
Sakr W et al. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol 1993; 150: 379–385.
Dhom G . Epidemic logic aspects of latent and clinically manifest carcinoma of the prostate. J Cancer Res din Oncol 1983; 106: 210–218.
Breslow N, Chan C, Dhom G . Latent carcinoma of the prostate at autopsy in seven areas. Int J Cancer 1997; 20: 680–688.
Yatani R, Chigusa I, Akazaki K . Geographic pathology of latent prostatic carcinoma. Int J Cancer 1982; 9: 611–616.
Hebert J et al. Nutritional and socio-economic factors in relation to prostate cancer mortality : a cross-national study. J Natl Cancer Inst 1998; 90: 1637–1647.
Chow C . Nutritional influence on cellular antioxidant defense systems. Am J Clin Nutr 1979; 32: 1066–1081.
Schrauzer G, White D, Schneider C . Cancer mortality correlation studies. Statistical associations with dietary selenium intakes. Bionorg Chem 1977; 7: 23–24.
Hunter D, Moris J, Stampfer M . A prospective study of selenium status and breast cancer risk. JAMA 1990; 264: 1128–1131.
Yoshiwaza K, Willett W, Morris S . Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. J Natl Cancer Inst 1998; 90: 1219–1224.
Clark L, Combs C, Turnbull B . Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin; a randomised controlled trial. JAMA 1996; 276: 1957–1963.
Clark L, Dalkin B, Kronegrad A . Decreased incidence of prostate cancer with selenium supplementation: results of a double-blind cancer prevention trial. Br J Urol 1998; 81: 730–734.
Wang Y, Heston W, Corr J . Decreased growth of established human prostate LNCaP tumours in nude mice fed a low fat diet. J Natl Cancer Inst 1995; 87: 1427–1432.
Fleshner N, Fair W, Huryk R . Vitamin E inhibits the high fat diet promoted growth of established human prostate LNCaP tumours in nude mice. J Urol 1999; 161: 1651–1654.
Chan J, Stampfer M, Ma J . Supplemental vitamin E and prostate cancer risk in a large cohort of men in the United States. Cancer Epidemiol Biomarkers Prev 1999; 8: 893–899.
Heinonen O, Albanes D, Virtamo J . Prostate cancer and supplementation with alfa-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst 1998; 90: 440–446.
Kamat A, Lamm D . Chemoprevention of urological cancer. J Urol 1999; 161: 1748–1760.
Schulman C et al. Prevention of prostate cancer. Scand J Urol Nephrol Suppl 2000; 205: 50–61.
Aboseif S, Shonohara K, Weidner N . The significance of prostatic intraepithelial neoplasia. Br J Urol 1995; 76: 355–359.
Berner A, Danielsen HE, Pettersen EO . DNA distribution in the prostate : normal gland, benign and premalignant lesions and subsequent adenocarcinomas. Anal Quant Cytol Histol 1993; 15: 247–252.
Davidson D, Bostwick DG, Qian J . Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma. Predictive accuracy in needle biopsies. J Urol 1995; 154: 1295–1299.
Krishnamurthi V, Klein EA, Levin HS . Probability of prostate cancer detection following diagnosis of prostatic intraepithelial neoplasia (PIN). J Urol 1999; 157(Suppl): 366.
Markham CW . Prostatic intraepithelial neoplasia: detection and correlation with invasive cancer in fine-needle biopsy. Urology 1989; 24(Suppl): 57–61.
Perachino M, Diciolo L, Barbetti V . Results of rebiopsy for suspected prostate cancer in symptomatic men with elevated PSA levels. Eur Urol 1997; 32: 155–159.
Raviv G, Zlotta AR, Jansen TH . Does prostate specific antigen and prostate-specific antigen density enhance the detection of prostate cancer in patients initially diagnosed to have prostatic intraepithelial neoplasia? Cancer 1996; 77: 2103–2108.
Rovner E, Schanne F, Malkowicz S . Transurethral biopsy of the prostate for persistently elevated or increasing prostate specific antigen following multiple negative transrectal biopsies. J Urol 1997; 158: 138–141.
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Goeman, L., Joniau, S., Ponette, D. et al. Is low-grade prostatic intraepithelial neoplasia a risk factor for cancer?. Prostate Cancer Prostatic Dis 6, 305–310 (2003). https://doi.org/10.1038/sj.pcan.4500681
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DOI: https://doi.org/10.1038/sj.pcan.4500681
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