The predictive value for prostate cancer of lesions that raise suspicion of concomitant carcinoma

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Abstract
BACKGROUND Suspicion of prostate carcinoma may persist after an initial negative biopsy result, and repeated biopsy is suggested. The authors assessed whether diagnostic follow‐up of men with an initial diagnosis of isolated, high‐grade prostatic intraepithelial neoplasia (HPIN) and a prostate biopsy suspicious for malignancy (PBSM) is needed. METHODS The frequency of isolated HPIN and PBSM was determined in 4057 participants of a population‐based screening study who underwent systematic sextant transrectal biopsy. The predictive value for prostate carcinoma of HPIN and PBSM was determined by performing repeated biopsies at 6‐week interval. The additional predictive value for malignant disease within a screened population was assessed by performing repeated biopsies at a 1‐year interval in 462 consecutively recruited men with an initial benign biopsy result. Participants were subjected to a second screening at a 4‐year interval. The biopsy and radical prostatectomy tumor features were determined. RESULTS Isolated HPIN and PBSM were diagnosed in 0.8% and 2.6% of biopsied men, respectively. The detection rates on repeated biopsy were 10.0% (3 of 30 men) for isolated HPIN, 38.7% (36 of 93 men) for PBSM, and 11.0% (51 of 462 men) for those with initial benign biopsy results. Except for two men (one with PBSM and one with HPIN), all others remained free of prostate carcinoma at their second screening. Features of the tumors that were detected after PBSM were comparable to those that were detected on initial biopsy, whereas the few tumors that were diagnosed after HPIN had highly favorable features. CONCLUSIONS Compared with men who have PBSM, men with isolated HPIN on initial biopsy are at no greater risk of being diagnosed with prostate carcinoma than if their initial biopsies were assessed as benign only. Moreover, the features of tumors that are diagnosed after an evaluation of HPIN warrant no early, extensive diagnostic follow‐up. Cancer 2001;92:524–34. © 2001 American Cancer Society.