Clinical significance of high grade and low grade prostate intraepithelial neoplasia

Authors

  • M.P. Melnychuk State institution of science “Research and practical center of preventive and clinical medicine”, State administrative department, Verkhnia st., 5, Kyiv, 01014, Ukraine, Ukraine https://orcid.org/0000-0003-1194-3496

DOI:

https://doi.org/10.26641/2307-0404.2021.2.234640

Keywords:

high and low grade prostate intraepithelial neoplasia, prostate cancer, malignant transformation

Abstract

Such premalignant conditions of prostate cancer (PC) as prostate intraepithelial neoplasia (PIN) are classified between benign and malignant ones. Contemporary evidence wheather PIN develops malignancy is limited and (LGPIN) data present varied results. Morphological and clinical differencies between high (HGPIN) and low grade PIN specimens in the prostate remain unclear. Aim of the work – to determine clinical significance and progression ability of high grade and low grade prostate intraepithelial neoplasia. The results of examination of 276 patients with PIN (152 patients with high grade PIN and 134 patients with low grade PIN) were assessed comparatively. During a 3 year follow-up repeated prostate biopsies were performed with 6 months interval to detect PC. Initial and repeated multifocal transrectal prostate biopsies from 12 samples were performed under transrectal ultrasonic guidance. There were statistically significant differences in PC detection rates between HGPIN and LGPIN. Patients with HGPIN had  malignization rate of 42.1% during a 3-year follow-up that was by 33.9% higher than in LGPIN patients. The spread of HGPIN lesions within prostate gland is a malignization risk factor. The mean malignization term of HGPIN is 18 months and of LGPIN – 30 months. Low and high grade PIN are gradual stages of cancerogenesis. PIN grade determines its clinical significance, while LGPIN has low malignization potential, HGPIN possesses morphological and clinical prostate characteristics similar to adenocarcinima.

References

Bosland MC, Ozten N, Eskra JN, Mahmud AM. A perspective on prostate carcinogenesis and chemoprevention. Curr Pharm Rep. 2015;1:258-65. doi: https://doi.org/10.1007/s40495-015-0031-0

Testa U, Castelli G, Pelisi E. Cellular and Molecular Mechanisms Underlying Prostate Cancer Development: Therapeutic Implications. Medicines. 2019;82:8-26. doi: https://doi.org/10.3390/medicines6030082

Xue J, Qin Z, Cai H. Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis. Oncotarget. 2017;8:23322-36. doi: https://doi.org/10.18632/oncotarget.15056

Mottet N, Bellmunt J, Bolla M. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017;71:618-29. doi: https://doi.org/10.1016/j.eururo.2016.08.003

Freitas GM, Andriole GL, Castro-Santamaria R. Extent of baseline prostate atrophy is associated with lower incidence of low and high-grade prostate cander on biopsy. Urology. 2017;103:161-6. doi: https://doi.org/10.1016/j.urology.2016.12.027

Jung SH, Shin S, Kim MS. Genetic progression of high grade prostatic intraepithelial neoplasia to prostate cancer. Eur. Urol. 2016;69:823-30. doi: https://doi.org/10.1016/j.eururo.2015.10.031

Bray F, Ferlay J, Soerjomataram I, Siegel RL. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: https://doi.org/10.3322/caac.21492

Zhou M. High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate. Modern Pathology. 2018;31:71-79. doi: https://doi.org/10.1038/modpathol.2017.138

Wiener S, Haddock P, Cusano J. Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue. Urology. 2017;110:161-5. doi: https://doi.org/10.1016/j.urology.2017.08.040

Najla A, Amer H, Nour A. Interobserver Variability in the Diagnosis of High-Grade Prostatic In¬traepithelial Neoplasia in a Tertiary Hospital in Northern Jordan. Clinical Pathology. 2018;13:1-4. doi: https://doi.org/10.1177/2632010X19898472

Szentirmaj E, Giannico GA. Intraductal carcinoma of the prostate. Pathologia. 2020;112:17-24. doi: https://doi.org/10.32074/1591-951X-5-20

Tolkach Y, Kristiansen G. Is high‐grade prostatic intraepithelial neoplasia (HGPIN) a reliable precursor for prostate carcinoma? Implications for clonal evolution and early detection strategies. The journal of pathology. 2018;244:389-93. doi: https://doi.org/10.1002/path.5045

Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol. 2018;15(1):55-66. doi: https://doi.org/10.1038/nrurol.2017.134

Haffner MC, Barbieri CE. Shifting Paradigms for High-grade Prostatic Intraepithelial Neoplasia. Eur Urology. 2016;69:831-33. doi: https://doi.org/10.1016/j.eururo.2015.11.020

Pukl M, Keyes S, Keyes M. Multi-scale tissue architecture analysis of favorable-risk prostate cancer: Correlation with biochemical recurrence. Investig Clin Urol. 2020;61(5):482-90. doi: https://doi.org/10.4111/icu.20200018

De Marzo AM, Haffner MC, Lotan TL, et al. Premalignancy in prostate cancer: rethinking what we know. Cancer Prev Res (Phila) 2016;9:648-56. doi: https://doi.org/10.1158/1940-6207.CAPR-15-0431

Haffner MC, Weier C, Xu M. Molecular evidence that invasive adenocarcinoma can mimic prostatic intraepithelial neoplasia (PIN) and intraductal carcinoma through retrograde glandular colonization. J Pathol 2015;238:31-41. doi: https://doi.org/10.1002/path.4628

Fowke JH, Motley SS. Statin use linked with a decrease in the conversion from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. Carcinogenesis. 2018;28;39(6):819-25. doi: https://doi.org/10.1093/carcin/bgy050

Xiao GQ, Golestani R, Pham H. Stratification of Atypical Intraepithelial Prostatic Lesions Based on Basal Cell and Architectural Patterns. American Journal of Clinical Pathology. 2019;153:407-16. doi: https://doi.org/10.1093/ajcp/aqz183

Downloads

Published

2021-06-18

How to Cite

1.
Melnychuk M. Clinical significance of high grade and low grade prostate intraepithelial neoplasia. Med. perspekt. [Internet]. 2021Jun.18 [cited 2024Apr.15];26(2):134-40. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/234640

Issue

Section

CLINICAL MEDICINE