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[Indication and strategy for further biopsies following the diagnosis of prostatic intra-epithelial neoplasia].
Indication et stratégie de nouvelles biopsies après diagnostic de néoplasie intra-épithéliale prostatique.
Prostatic Intraepithelial Neoplasia (PIN) lesions are characterized by proliferation of the epithelial cells lining prostatic ducts and acini. Only high grade PIN lesions (grades 2 and 3) should be reported on biopsy histology reports. The authors present a review of the literature. The clinical importance of demonstration of isolated PIN lesions on prostatic biopsies is based on the high risk of associated invasive cancer present in the prostatic gland in 22% to 100% of cases, usually adjacent to the zone presenting PIN lesions. This risk increases as the grade of the PIN lesion increases, when there is a clinical (abnormal digital rectal examination) or laboratory suspicion (elevation PSA > 10 ng/ml), or in elderly patients. Identification of a high grade PIN does not require any immediate treatment decision. PSA assays do not need to be repeated. A new series of biopsies is recommended after three months. The optimal strategy for the choice of the new biopsy sites has not been defined. In the case of a first series of sextant biopsies, a new series of biopsies is recommended, combining biopsies directed towards the site of PIN lesions (3 biopsies in the site of PIN lesions, 2 biopsies adjacent to this site) and systematized biopsies of the same side. In the case of a first series of non-systematized biopsies, a new series of systematized biopsies is recommended.
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