Progression of Prostatic Intraepithelial Neoplasia to Early Invasive Adenocarcinoma

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Abstract
Objective: High-grade prostatic intraepithelial neoplasia is the most likely precursor of adenocarcinoma. This report describes the diagnostic criteria for prostatic intraepithelial neoplasia, its clinical significance, and the evidence suggesting that it progresses to prostatic adenocarcinoma. Methods: We reviewed the published evidence linking prostatic intraepithelial neoplasia and prostate cancer. Results: Prostatic intraepithelial neoplasia has a high predictive value as a marker for adenocarcinoma, and its identification in biopsy specimens of the prostate warrants further search for concurrent invasive carcinoma. Most studies suggest that, if untreated, prostatic intraepithelial neoplasia will progress to early carcinoma, although only indirect evidence exists to support this hypothesis. Androgen deprivation therapy decreases the prevalence and extent of prostatic intraepithelial neoplasia, suggesting that this form of treatment may play a role in chemoprevention. Prostatic intraepithelial neoplasia does not appear to elevate serum PSA concentration. It is associated with progressive abnormalities of phenotype and genotype which are intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. Conclusion: Virtually all data indicate that high-grade prostatic intraepithelial is premalignant, accounting for most if not all cases of prostate cancer.

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