Background: Proliferative inflammatory atrophy (PIA) has been involved in prostatic carcinogenesis. Proliferative epithelium in PIA may progress to high-grade prostatic intraepithelial neoplasia (HGPIN) or adenocarcinoma or both. However, little is known about the clinical significance of a PIA finding in negative prostate biopsies (PBs). A preliminary review of the current literature has been done. (1st article) Objectives: 1)Determine the incidence of PIA in PBs with and without prostate cancer (PCa) and RPs, its association to HGPIN and tumor aggressiveness. (2nd article) 2)Determine the prognostic value of PIA finding in a negative PB regarding PCa risk and agressiveness. (3rd article) Methods: Retrospective and observational study of PIA lesion in 528 extended PBs and 200 RPs. Outcome measurements: PIA, HGPIN, PCa incidence, Gleason score, clinical and pathologic tumor stage and insignificant tumor rate. (2nd article) Retrospective and observational study of 474 men scheduled to repeated PBs. Assessment of PIA and its extension in the previous biopsy. PCa detection rate and tumor aggressiveness. Age, serum total PSA, free PSA, percent free PSA (%fPSA), digital rectal exam (DRE), prostate volume (PV), PSA density (PSAD), PSA kinetics (PSAV and PSADT) findings of PIA and HGPIN and number of affected cores in previous PBs were included in the univariate and multivariate analysis. Aggressive tumors were considered when any Gleason pattern 4 was found. (3rd article) Results: Overall incidence of PIA and HGPIN was 30. 3% and 54% in extended PBs. In RPS, the incidence was 30. 5% and 72%, respectively. No significant association was found between PIA and HGPIN. Overall PCa detection rate in PBs was 38. 1%. PCa was found in 27. 5% PBs with PIA and 42. 7% of those without PIA, p 0. 001. In contrast, PCa was detected in 50. 9% of PBs with HGPIN and 23% of those without HGPIN, p=0. 001. Multivariate analysis revealed that PIA decreased the risk of PCa, OR: 0. 59 (95%CI:0. 37-0. 95), p=0. 029, while HGPIN increased OR: 3. 16 (95%CI:2. 04-4. 90), p=0. 001. PIA was not related to Gleason grade and clinical stage, however it was associated to an insignificant tumors increase, OR:3. 08 (95%CI:1. 09-8. 7), p=0. 033. The information in RPs suggests that PIA is associated with less aggressive tumors and a higher probability of insignificant tumors. (2nd article) In the analysis of 474 men that underwent repeated PBs, PCa was detected in 133 men (28. 1%). Age, serum total PSA, %fPSA, PV, PSAD, PSAV, PSADT and PIA finding were significantly associated to PCa detection. However, only age, OR:1. 061 (95%CI:1. 025-1. 098), p=0. 001; DRE, OR:1. 755 (95%CI:1. 054-2. 923), p=0. 031; %fPSA, OR:0. 963 (95%CI: 0. 933-0. 996), p=0. 028; PV, OR:0. 983 (95%CI:0. 972-0. 994), p=0. 002 and PIA finding, OR:0. 491 (95%CI:0. 291-0. 828), p=0. 008, were independent predictors of PCa detection. PCa was found in 18% of 159 men with previous PIA finding while in 33% of 315 men without previous PIA (p=0. 001). None of the studied parameters including PIA in the previous biopsy were related with subsequent PCa aggressiveness. (3rd article) Conclusions: 1)PIA lesion is found in 30% of extended prostate biopsies, only 27% of PBs with PIA had PCa. PIA incidence in RPs was 32%. 2)The finding of PIA in prostate biopsies is not related with HGPIN finding in PBs nor in RPs. PIA finding is related to a lower risk of associated PCa. If PCa is present in prostate biopsies, the finding of PIA is associated to less aggressive and insignificant tumors. The presence of PIA in RPs was associated to less aggressive and insignificant tumors. 3)PIA lesion can be identified in 30% of patients with a negative PB. PIA finding in negative prostatic biopsies represents a decreased risk of PCa detection in future repeated PBs due to persistent PCa suspicion. There is no relation between PIA lesion in negative prostate biopsies and PCa aggressiveness in further biopsies.
| Date of Award | 20 Jun 2016 |
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| Original language | English |
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| Awarding Institution | - Vall d'Hebron University Hospital (HUVH)
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| Supervisor | Juan Morote Robles (Director) |
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