IS REPEAT PROSTATE BIOPSY FOR HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA NECESSARY AFTER ROUTINE 12-CORE SAMPLING? GARY K. LEFKOWITZ, GURDIP S. SIDHU, PABLO TORRE, HERBERT LEPOR, AND SAMIR S. TANEJA ABSTRACT Objectives. To determine whether repeat biopsy is necessary when the diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) is made with a 12-core biopsy. Repeated biopsy has been recommended for individuals with HGPIN noted on sextant prostate biopsy because of the high likelihood of cancer detection. Recently, we have recommended the routine use of 12 cores, rather than 6, to improve cancer detection. Methods. The charts of all patients undergoing prostate biopsy during a 2-year period at the Manhattan Veterans Administration Medical Center were reviewed. Patients diagnosed with HGPIN on a 12-core biopsy were identified, and those undergoing a repeat 12-core biopsy within 1 year of the initial biopsy were evaluated to determine the rate of cancer detection. Results. A total of 619 men underwent biopsy during the study period. Of 103 men diagnosed with HGPIN, 43 underwent a repeat biopsy within 1 year at the discretion of the managing urologist. The mean age and median prostate-specific antigen level of those undergoing a repeat biopsy was 65.5 years and 5.37 ng/mL, respectively. At the time of the repeat biopsy, 1 patient was found to have cancer (2.3%), 20 had HGPIN (46.5%), 20 had benign pathologic findings (46.5%), and 1 patient (2.3%) had atypical small acinar proliferation. Conclusions. A repeat biopsy after the diagnosis of HGPIN on 12-core prostate biopsy rarely results in cancer detection. In the absence of other factors increasing the suspicion of cancer, immediate repeat biopsy for HGPIN diagnosed on a 12-core biopsy is unnecessary. UROLOGY 58: 999–1003, 2001. © 2001, Elsevier Science Inc. H igh-grade prostatic intraepithelial neoplasia (HGPIN) is defined as an abnormal prolifera- tion of the prostatic ducts and acini, with nuclear changes similar to prostate cancer. Like prostate cancer, PIN is often a multifocal lesion and coexists with cancer in more than 85% of cases. 1 This is not an uncommon entity, with 4.4% to 25% of men having PIN on transrectal needle biopsies per- formed by urologists in practice. 2 HGPIN has long been thought of as the potential precursor for adenocarcinoma of the prostate. 3 Many studies have illustrated that HGPIN is a risk factor for prostate cancer, with 27% to 100% of patients having prostate cancer on an immediately repeated biopsy in different series. 4–6 HGPIN has been illustrated to have an even higher predictive value for cancer than patient age and serum pros- tate-specific antigen (PSA) level. 7 Because of this association, immediate follow-up biopsies, along with serial repeat biopsies at varying intervals, have been recommended for these patients. Levine et al. 8 previously showed that obtaining two consecutive sets of transrectal ultrasound (TRUS)-guided sextant biopsies of the prostate in- creased the detection of pathologically organ-con- fined disease. This was done without additional morbidity or cost. Since that initial publication, we have routinely performed a 12-core sampling of the prostate for individuals presenting at our insti- tution with elevated PSA levels. We have proposed that when performing a 12-core biopsy, the repeat biopsy generally recommended after a diagnosis of HGPIN on sextant biopsy has already been effec- From the Departments of Urology and Pathology, Manhattan Veteran’s Administration Medical Center and New York Univer- sity School of Medicine, New York, New York Reprint requests: Samir S. Taneja, M.D., 540 First Avenue, Suite 10R, New York, NY 10016 Submitted: July 2, 2001, accepted (with revisions): August 16, 2001 ADULT UROLOGY CME ARTICLE © 2001, ELSEVIER SCIENCE INC. 0090-4295/01/$20.00 ALL RIGHTS RESERVED PII S0090-4295(01)01436-4 999