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Follow-up of patients with isolated mono and plurifocal High Grade Prostatic Intraepithelial Neoplasia (HGPIN) on initial prostate needle biopsy
653 FOLLOW-UP OF PATIENTS WITH ISOLATED MONO AND PLURIFOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN) ON INITIAL PROSTATE NEEDLE BIOPSY Roscieno M.‘, Scattoni V.‘, Freschi Ghezri M.‘,Montorsi F.‘, Rigatti P.’
M.*, Raber
M.‘,
Colombo
R.‘,
Bertini
654 PROSPECTIVE EVALUATION INTRAEPITHELIAL NEOPLASIA CYSTOPROSTATECTOMIES
OF HIGH-GRADE PROSTATIC IN PROSTATE BIOPSIES FROM
R.,
‘Urology, Vita e Salute University, H S Raffaele, Milan, Italy, ‘Pathology. Vita e Salute Urology, H S Raffaele, Milan, Italy
INTRODUCTION & OBJECTIVES: Histological diagnosis of HGPIN on needle biopsy increases the risk of detecting adenocarcinoma on repeat biopsy. We evaluated the diagnostic value of early repeated ten-twelve cores prostate needle biopsy in patients with first diagnosis of HGPIN.
MATERIAL & METHODS: From January 1995 to July 2001, 21 I4 patients underwent IO-12 cores systematic TRUS-guided biopsy. At least five biopsies were performed in each lobe; m addition to sextant biopsies, cores were taken from the far lateral region of the gland and the transition zone according to the gland volume (ten cores for prostate ~50 g; I2 cores in prostate a50 g) in 109 patients (5,l%) isolated mono- and plurifocal HGPIN was found, and 35 of them underwent a second set of systematic biopsies within a I2 months time span. RESULTS: Adenocarcinoma was detected in the second biopsy in I6 of the 3.5 patients with HGPIN at first histology (46%), while in I4 patients HGPIN was confirmed and in 5 cases benign prostatic hyperplasia (BPH) was diagnosed. Of the 16 patients with adenocarcinoma at second biopsy, I3 (8 I Yc)had plurifocal HGPIN at the first biopsy. Adenocarcinoma was diagnosed at the second biopsy in 18% and 68% of the patients with mono- and plurifocal HGPIN at the first biopsy respectively (p
Hammerer Peter’, Prange Wilhelm2, Erbersdobler Hautmann Richard“, Huland Hartwig’
Andreas’,Hautmann Stefan ’ .
lUrology, University Hospital Hamburg, Hamburg, Germany, ZPathology, University Hospital Cologne, Cologne, Germany, 3Pathology, University Hospital Hamburg, Hamburg, Germany, YJrology, University Hospital Ulm. Ulm, Germany INTRODUCTION & OBJECTIVES: Aim of this study was to analyse the prevalence and significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens of prostates without clinical findings suspicious for prostate cancer. MATERIAL & METHODS: Sextant biopsies were performed on a series of 83 cystoprostatectomy specimens removed for bladder cancer. Patients with abnormal digital rectal examination or elevated PSA were excluded from this study. Age of the patients ranged from 38-83 years (median 64 years). Biopsies were performed after the cystoprostatectomy on the specimen itself. The prostate was serially blocked at 4-mm intervals. HGPIN was assigned according to the modified two-grade system as reviewed by Bostwick. RESULTS: We identified HGPIN foci in 82 of 83 prostatic glands (99%). number of foci of HGPIN ranged from O-80 (median 20). Total volume of HGPIN ranged from 0 to 3.45 cm3 (median 0.17). Sextant biopsies of 29 of 83 cases (35%) harboured HGPIN but no prostate cancer whereas in 6 cases (7%) both HGPIN and PCs were found. There was a positive correlation between the number of biopsies with HGPIN and the number of foci of HGPIN in the specimen as well as prostate cancer in the specimen. CONCLUSIONS: The presence of HGPIN in prostate biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates.
656
655 CHROMOGRANIN PROSTATE
DETERMINATION
IN
THE
DIAGNOSIS
OF
Prayer-Galetti Tommaso’ , Basso Daniela*, Fulcoli Vittorio’ , Pinto Francesco’ , De Marco Vincenzo’,Sacco Emilio’, Breda Alberta’ , Nigro Filippo’ , Plebani
FOLLOW-UP
OF 31 CASES OF PARTIAL ATROPHY
De LaTaille A.', Zerbib M.l, Boccon Gibod L.A.2, Conquy S.‘.Amsellem Saighi D.‘,Thiounn N.‘, Flam T.‘, Debre B.’ ‘Urology, Cochin, Paris, France, 2Pathology, Trousseau,
Mario2 ‘Urology, University, Padova, Italy, *Laboratory
Medicine, University,
Padova,
Italy INTRODUCTION & OBJECTIVES: To ascertain whether the power of serology assessing prostate cancer (PCs) may be enhanced by plasma determination of the neuroendocrine marker, Chromogranin A (CgA). MATERIAL & METHODS: Our series consisted of I39 patients consequently submitted to transperineal ultrasound guided prostate biopsies for the clinical suspect of PCs: the diagnosis was PC in 56 cases and benign prostatic hyperplasia (BPH) in the remaining 83 patients. CgA was assayed in plasma samples; sera were used to measure total PSA (tPSA) and free/total PSA
(f/tPSA) RESULTS: PCs patients had significantly lower f/t PSA ratio (t=6.5, pcO.001) than BPH patients. f/t PSA was the most effective index for discriminating between PCs and BPH (under ROC curve area=81.4%), the performance of tPSA and CgA being similar (under ROC curve areas, 61.7% and 64.5% respectively). When f/tPSA and CgA were combined, the diagnostic sensitivity was enhanced (from 57 to 730/c), while the specificity was only slightly reduced (from 89% to 80%). Unlike tPSA and f/tPSA, CgA was correlated with the Gleason PCs grade (Chi-Square=3.62, p
CLINICAL
CANCER PATIENTS
Urology Supplements
1 (2002) No. 1, pp. 166
D.‘,
Paris, France
INTRODUCTION & OBJECTIVES: Partial atrophy is one of the benign lesions on needle biopsy that can be confused with well-differentiated adenocarcinoma of the prostate (other terms used in the literature are lobular atrophy associated hyperplasia and hyperplasia, hyperplastic atrophy, postatrophic hyperplasia). Recently, some authors considered this lesion as a precursor of prostate cancer. We evaluated retrospectively the clinical follow-up of 3 1 patients who had an elevated serum PSA and partial atrophy on biopsy. MATERIAL & METHODS: Between 1993 and 2001, 120 patients with elevated serum PSA and/or abnormal digital rectal examination had negative prostate needle biopsies. Thirty-one of them (26%) had a diagnostic of partial atrophy of the prostate. Patients were evaluated every 6 months to do a clinical examination and to measure serum PSA levels and prostate volume. Eight patients were re-biopsied. RESULTS: Mean PSA was 9.8 ng/mL (range: 50.5.80.8), F/T PSA 16.1% (range 7-27) and prostate volume 43.5 g (range 20.88). With a mean follow-up of 32.9 months (range 6.83), no patient developed a prostate cancer. Serum PSA level did not increase and F/T PSA ratio did not change. In the case of four patients who were rebiopsied, partial atrophy was confirmed without adenocarcinoma. Prostate volume increased statistically during the follow-up (p=O.O06). CONCLUSIONS: Partial atrophy is not associated with prostate cancer in our study. Inflammation associated with atrophic glands could explain a high serum PSA level and a low F/T PSA ratio. The natural history of this diagnosis remains unanswered and further molecular and clinical studies are needed.
M.*, Raber
M.‘,
Colombo
R.‘,
Bertini
654 PROSPECTIVE EVALUATION INTRAEPITHELIAL NEOPLASIA CYSTOPROSTATECTOMIES
OF HIGH-GRADE PROSTATIC IN PROSTATE BIOPSIES FROM
R.,
‘Urology, Vita e Salute University, H S Raffaele, Milan, Italy, ‘Pathology. Vita e Salute Urology, H S Raffaele, Milan, Italy
INTRODUCTION & OBJECTIVES: Histological diagnosis of HGPIN on needle biopsy increases the risk of detecting adenocarcinoma on repeat biopsy. We evaluated the diagnostic value of early repeated ten-twelve cores prostate needle biopsy in patients with first diagnosis of HGPIN.
MATERIAL & METHODS: From January 1995 to July 2001, 21 I4 patients underwent IO-12 cores systematic TRUS-guided biopsy. At least five biopsies were performed in each lobe; m addition to sextant biopsies, cores were taken from the far lateral region of the gland and the transition zone according to the gland volume (ten cores for prostate ~50 g; I2 cores in prostate a50 g) in 109 patients (5,l%) isolated mono- and plurifocal HGPIN was found, and 35 of them underwent a second set of systematic biopsies within a I2 months time span. RESULTS: Adenocarcinoma was detected in the second biopsy in I6 of the 3.5 patients with HGPIN at first histology (46%), while in I4 patients HGPIN was confirmed and in 5 cases benign prostatic hyperplasia (BPH) was diagnosed. Of the 16 patients with adenocarcinoma at second biopsy, I3 (8 I Yc)had plurifocal HGPIN at the first biopsy. Adenocarcinoma was diagnosed at the second biopsy in 18% and 68% of the patients with mono- and plurifocal HGPIN at the first biopsy respectively (p
Hammerer Peter’, Prange Wilhelm2, Erbersdobler Hautmann Richard“, Huland Hartwig’
Andreas’,Hautmann Stefan ’ .
lUrology, University Hospital Hamburg, Hamburg, Germany, ZPathology, University Hospital Cologne, Cologne, Germany, 3Pathology, University Hospital Hamburg, Hamburg, Germany, YJrology, University Hospital Ulm. Ulm, Germany INTRODUCTION & OBJECTIVES: Aim of this study was to analyse the prevalence and significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens of prostates without clinical findings suspicious for prostate cancer. MATERIAL & METHODS: Sextant biopsies were performed on a series of 83 cystoprostatectomy specimens removed for bladder cancer. Patients with abnormal digital rectal examination or elevated PSA were excluded from this study. Age of the patients ranged from 38-83 years (median 64 years). Biopsies were performed after the cystoprostatectomy on the specimen itself. The prostate was serially blocked at 4-mm intervals. HGPIN was assigned according to the modified two-grade system as reviewed by Bostwick. RESULTS: We identified HGPIN foci in 82 of 83 prostatic glands (99%). number of foci of HGPIN ranged from O-80 (median 20). Total volume of HGPIN ranged from 0 to 3.45 cm3 (median 0.17). Sextant biopsies of 29 of 83 cases (35%) harboured HGPIN but no prostate cancer whereas in 6 cases (7%) both HGPIN and PCs were found. There was a positive correlation between the number of biopsies with HGPIN and the number of foci of HGPIN in the specimen as well as prostate cancer in the specimen. CONCLUSIONS: The presence of HGPIN in prostate biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates.
656
655 CHROMOGRANIN PROSTATE
DETERMINATION
IN
THE
DIAGNOSIS
OF
Prayer-Galetti Tommaso’ , Basso Daniela*, Fulcoli Vittorio’ , Pinto Francesco’ , De Marco Vincenzo’,Sacco Emilio’, Breda Alberta’ , Nigro Filippo’ , Plebani
FOLLOW-UP
OF 31 CASES OF PARTIAL ATROPHY
De LaTaille A.', Zerbib M.l, Boccon Gibod L.A.2, Conquy S.‘.Amsellem Saighi D.‘,Thiounn N.‘, Flam T.‘, Debre B.’ ‘Urology, Cochin, Paris, France, 2Pathology, Trousseau,
Mario2 ‘Urology, University, Padova, Italy, *Laboratory
Medicine, University,
Padova,
Italy INTRODUCTION & OBJECTIVES: To ascertain whether the power of serology assessing prostate cancer (PCs) may be enhanced by plasma determination of the neuroendocrine marker, Chromogranin A (CgA). MATERIAL & METHODS: Our series consisted of I39 patients consequently submitted to transperineal ultrasound guided prostate biopsies for the clinical suspect of PCs: the diagnosis was PC in 56 cases and benign prostatic hyperplasia (BPH) in the remaining 83 patients. CgA was assayed in plasma samples; sera were used to measure total PSA (tPSA) and free/total PSA
(f/tPSA) RESULTS: PCs patients had significantly lower f/t PSA ratio (t=6.5, pcO.001) than BPH patients. f/t PSA was the most effective index for discriminating between PCs and BPH (under ROC curve area=81.4%), the performance of tPSA and CgA being similar (under ROC curve areas, 61.7% and 64.5% respectively). When f/tPSA and CgA were combined, the diagnostic sensitivity was enhanced (from 57 to 730/c), while the specificity was only slightly reduced (from 89% to 80%). Unlike tPSA and f/tPSA, CgA was correlated with the Gleason PCs grade (Chi-Square=3.62, p
CLINICAL
CANCER PATIENTS
Urology Supplements
1 (2002) No. 1, pp. 166
D.‘,
Paris, France
INTRODUCTION & OBJECTIVES: Partial atrophy is one of the benign lesions on needle biopsy that can be confused with well-differentiated adenocarcinoma of the prostate (other terms used in the literature are lobular atrophy associated hyperplasia and hyperplasia, hyperplastic atrophy, postatrophic hyperplasia). Recently, some authors considered this lesion as a precursor of prostate cancer. We evaluated retrospectively the clinical follow-up of 3 1 patients who had an elevated serum PSA and partial atrophy on biopsy. MATERIAL & METHODS: Between 1993 and 2001, 120 patients with elevated serum PSA and/or abnormal digital rectal examination had negative prostate needle biopsies. Thirty-one of them (26%) had a diagnostic of partial atrophy of the prostate. Patients were evaluated every 6 months to do a clinical examination and to measure serum PSA levels and prostate volume. Eight patients were re-biopsied. RESULTS: Mean PSA was 9.8 ng/mL (range: 50.5.80.8), F/T PSA 16.1% (range 7-27) and prostate volume 43.5 g (range 20.88). With a mean follow-up of 32.9 months (range 6.83), no patient developed a prostate cancer. Serum PSA level did not increase and F/T PSA ratio did not change. In the case of four patients who were rebiopsied, partial atrophy was confirmed without adenocarcinoma. Prostate volume increased statistically during the follow-up (p=O.O06). CONCLUSIONS: Partial atrophy is not associated with prostate cancer in our study. Inflammation associated with atrophic glands could explain a high serum PSA level and a low F/T PSA ratio. The natural history of this diagnosis remains unanswered and further molecular and clinical studies are needed.