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High Grade Prostatic Intraepithelial Neoplasia

MedGen UID:
217002
•Concept ID:
C1168327
•
Neoplastic Process
Synonyms: High-Grade Intraepithelial Neoplasia of Prostate; High-Grade Intraepithelial Neoplasia of the Prostate; High-Grade PIN; High-Grade Prostatic Intraepithelial Neoplasia

Definition

Prostatic intraepithelial neoplasia characterized by the presence of morphologically malignant cells lining the acini and ducts. The malignant cells are enlarged, contain prominent nucleoli, and have increased nuclear/cytoplasmic ratio. The malignant cells may grow within the ducts and acini in four architectural patterns: flat, tufting, micropapillary, and cribriform. The presence of high grade prostatic intraepithelial neoplasia in needle biopsy is a risk factor for the subsequent detection of carcinoma on repeat biopsy. [from NCI]

Professional guidelines

PubMed

The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia.
Morote J, Schwartzmann I, Celma A, Roche S, de Torres IM, Mast R, Semidey ME, Regis L, Santamaria A, Planas J, Trilla E
BJU Int 2022 May;129(5):627-633. Epub 2021 Aug 25 doi: 10.1111/bju.15568. PMID: 34375498
The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K
Arch Pathol Lab Med 2021 Apr 1;145(4):461-493. doi: 10.5858/arpa.2020-0015-RA. PMID: 32589068
Differential Diagnosis of Intraductal Lesions of the Prostate.
Wobker SE, Epstein JI
Am J Surg Pathol 2016 Jun;40(6):e67-82. doi: 10.1097/PAS.0000000000000609. PMID: 26848801

Recent clinical studies

Etiology

Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate.
Dantés-Durán MA, Castelán-Maldonado EE, Palacios-Saucedo GDC
Gac Med Mex 2023;159(2):91-95. doi: 10.24875/GMM.M22000752. PMID: 37094236
The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K
Arch Pathol Lab Med 2021 Apr 1;145(4):461-493. doi: 10.5858/arpa.2020-0015-RA. PMID: 32589068
High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate.
Zhou M
Mod Pathol 2018 Jan;31(S1):S71-79. doi: 10.1038/modpathol.2017.138. PMID: 29297491
Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy.
Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI
Nat Rev Urol 2018 Jan;15(1):55-66. Epub 2017 Aug 31 doi: 10.1038/nrurol.2017.134. PMID: 28858331
The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours.
Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE
Eur Urol 2016 Jul;70(1):106-119. Epub 2016 Mar 17 doi: 10.1016/j.eururo.2016.02.028. PMID: 26996659

Diagnosis

WHO Classification of Tumours fifth edition: evolving issues in the classification, diagnosis, and prognostication of prostate cancer.
Kench JG, Amin MB, Berney DM, Compérat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Moch H, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tsuzuki T, Turjalic S, van der Kwast TH, Zhou M, Srigley JR
Histopathology 2022 Oct;81(4):447-458. Epub 2022 Aug 2 doi: 10.1111/his.14711. PMID: 35758185Free PMC Article
The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K
Arch Pathol Lab Med 2021 Apr 1;145(4):461-493. doi: 10.5858/arpa.2020-0015-RA. PMID: 32589068
Molecular Pathology of High-Grade Prostatic Intraepithelial Neoplasia: Challenges and Opportunities.
Trabzonlu L, Kulac I, Zheng Q, Hicks JL, Haffner MC, Nelson WG, Sfanos KS, Ertunc O, Lotan TL, Heaphy CM, Meeker AK, Yegnasubramanian S, De Marzo AM
Cold Spring Harb Perspect Med 2019 Apr 1;9(4) doi: 10.1101/cshperspect.a030403. PMID: 30082453Free PMC Article
Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy.
Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI
Nat Rev Urol 2018 Jan;15(1):55-66. Epub 2017 Aug 31 doi: 10.1038/nrurol.2017.134. PMID: 28858331
High-grade prostatic intraepithelial neoplasia.
Bostwick DG, Qian J
Mod Pathol 2004 Mar;17(3):360-79. doi: 10.1038/modpathol.3800053. PMID: 14739906

Therapy

Premalignancy in Prostate Cancer: Rethinking What we Know.
De Marzo AM, Haffner MC, Lotan TL, Yegnasubramanian S, Nelson WG
Cancer Prev Res (Phila) 2016 Aug;9(8):648-56. Epub 2016 Jan 26 doi: 10.1158/1940-6207.CAPR-15-0431. PMID: 26813971
Potential stages for prostate cancer prevention with selenium: implications for cancer survivors.
Facompre N, El-Bayoumy K
Cancer Res 2009 Apr 1;69(7):2699-703. Epub 2009 Mar 24 doi: 10.1158/0008-5472.CAN-08-4359. PMID: 19318549Free PMC Article
Distinguishing atrophy and high-grade prostatic intraepithelial neoplasia from prostatic adenocarcinoma with and without previous adjuvant hormone therapy with the aid of cytokeratin 5/6.
Abrahams NA, Bostwick DG, Ormsby AH, Qian J, Brainard JA
Am J Clin Pathol 2003 Sep;120(3):368-76. doi: 10.1309/3ynlxcr33817jltr. PMID: 14502799
Significance of high-grade prostatic intraepithelial neoplasia on prostate biopsy.
Meng MV, Shinohara K, Grossfeld GD
Urol Oncol 2003 Mar-Apr;21(2):145-51. doi: 10.1016/s1078-1439(03)00009-7. PMID: 12856644
Progression of prostatic intraepithelial neoplasia to early invasive adenocarcinoma.
Bostwick DG
Eur Urol 1996;30(2):145-52. doi: 10.1159/000474164. PMID: 8875195

Prognosis

WHO Classification of Tumours fifth edition: evolving issues in the classification, diagnosis, and prognostication of prostate cancer.
Kench JG, Amin MB, Berney DM, Compérat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Moch H, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tsuzuki T, Turjalic S, van der Kwast TH, Zhou M, Srigley JR
Histopathology 2022 Oct;81(4):447-458. Epub 2022 Aug 2 doi: 10.1111/his.14711. PMID: 35758185Free PMC Article
The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K
Arch Pathol Lab Med 2021 Apr 1;145(4):461-493. doi: 10.5858/arpa.2020-0015-RA. PMID: 32589068
Do not misinterpret intraductal carcinoma of the prostate as high-grade prostatic intraepithelial neoplasia!
Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Zhou M, Montorsi F
Eur Urol 2012 Sep;62(3):518-22. Epub 2012 Jun 5 doi: 10.1016/j.eururo.2012.05.062. PMID: 22688084
High-grade prostatic intraepithelial neoplasia.
Bostwick DG, Qian J
Mod Pathol 2004 Mar;17(3):360-79. doi: 10.1038/modpathol.3800053. PMID: 14739906
Prostatic intraepithelial neoplasia.
Bostwick DG
Curr Urol Rep 2000 May;1(1):65-70. doi: 10.1007/s11934-000-0037-x. PMID: 12084343

Clinical prediction guides

The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.
Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K
Arch Pathol Lab Med 2021 Apr 1;145(4):461-493. doi: 10.5858/arpa.2020-0015-RA. PMID: 32589068
High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate.
Zhou M
Mod Pathol 2018 Jan;31(S1):S71-79. doi: 10.1038/modpathol.2017.138. PMID: 29297491
The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours.
Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE
Eur Urol 2016 Jul;70(1):106-119. Epub 2016 Mar 17 doi: 10.1016/j.eururo.2016.02.028. PMID: 26996659
High-grade prostatic intraepithelial neoplasia.
Bostwick DG, Qian J
Mod Pathol 2004 Mar;17(3):360-79. doi: 10.1038/modpathol.3800053. PMID: 14739906
Prostatic intraepithelial neoplasia.
Bostwick DG
Curr Urol Rep 2000 May;1(1):65-70. doi: 10.1007/s11934-000-0037-x. PMID: 12084343

Recent systematic reviews

Chemoprevention of prostate cancer in men with high-grade prostatic intraepithelial neoplasia (HGPIN): a systematic review and adjusted indirect treatment comparison.
Cui K, Li X, Du Y, Tang X, Arai S, Geng Y, Xi Y, Xu H, Zhou Y, Ma W, Zhang T
Oncotarget 2017 May 30;8(22):36674-36684. doi: 10.18632/oncotarget.16230. PMID: 28415774Free PMC Article
Diagnostic Difficulties With Atrophy, Atypical Adenomatous Hyperplasia, and Atypical Small Acinar Proliferation: A Systematic Review of Current Literature.
Kowalewski A, Szylberg Ł, Skórczewska A, Marszałek A
Clin Genitourin Cancer 2016 Oct;14(5):361-365. Epub 2016 Feb 23 doi: 10.1016/j.clgc.2016.02.003. PMID: 26992486
The PCA3 test for guiding repeat biopsy of prostate cancer and its cut-off score: a systematic review and meta-analysis.
Luo Y, Gou X, Huang P, Mou C
Asian J Androl 2014 May-Jun;16(3):487-92. doi: 10.4103/1008-682X.125390. PMID: 24713827Free PMC Article
Clinical significance of proliferative inflammatory atrophy in prostate biopsy.
Celma A, Servián P, Planas J, Placer J, Quilez MT, Arbós MA, de Torres I, Morote J
Actas Urol Esp 2014 Mar;38(2):122-6. Epub 2013 Oct 13 doi: 10.1016/j.acuro.2013.04.008. PMID: 24129226
Prostate saturation biopsy following a first negative biopsy: state of the art.
Maccagnano C, Gallina A, Roscigno M, Raber M, Capitanio U, Saccà A, Pellucchi F, Suardi N, Abdollah F, Montorsi F, Rigatti P, Scattoni V
Urol Int 2012;89(2):126-35. Epub 2012 Jul 19 doi: 10.1159/000339521. PMID: 22814003

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