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Inicio Actas Urológicas Españolas (English Edition) Current significance of the finding of high grade prostatic intraepithelial neop...
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Vol. 38. Issue 4.
Pages 270-275 (May 2014)
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Vol. 38. Issue 4.
Pages 270-275 (May 2014)
Review article
Current significance of the finding of high grade prostatic intraepithelial neoplasia in the prostate biopsy
Significado actual del hallazgo de la neoplasia intraepitelial prostática de alto grado en la biopsia prostática
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J. Bastarós
Corresponding author
jmbastar@vhebron.net

Corresponding author.
, J. Placer, A. Celma, J. Planas, J. Morote
Servicio de Urología y Trasplante Renal, Hospital Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Abstract
Introduction

High grade prostatic intraepithelial neoplasia (HGPIN) is regarded as a precursor of prostate cancer (PC). However, its relationship to cancer has changed throughout the literature, being currently poorly defined and remains controversial for urologists in their clinical practice. Because of his frequency and the impact on patient outcomes that the lack of consensus clinical attitude could carry out, it seems advisable to review the understanding of this disease.

Objective

The aim of this literature review is to summarize the main features of this entity (histopathology, molecular, epidemiological) and evaluate their relationship with prostate adenocarcinoma, explaining the variation of incidence seen in the literature and the clinical significance of their finding.

Material and Methods

Review of the literature, based on the research and analysis of publications found in Pubmed with the words “prostate” and “intraepithelial neoplasms”.

Results

The HGPIN detection rate has increased to the extent that it has increased the number of punctures in prostate biopsies. With the current biopsy schemes (10–12 punctures), the detection rate of PC in repeat biopsies is similar in patients with and without isolated HGPIN. However, HGPIN multifocality predicts increased risk of PC detection in repeat biopsy.

Conclusion

HGPIN detection is common with current biopsy schemes. Its genetic relationship with PC is clear and its multifocality is the most important predictor factor of PC.

Keywords:
Prostate cancer
Prostatic intraepithelial neoplasia
Oncogenesis
Resumen
Introducción

La neoplasia intraepitelial prostática de alto grado (HGPIN) es considerada una entidad precursora del cáncer de próstata (CP). La predicción de su coexistencia con CP ha variado a lo largo del tiempo y hoy en día están poco definidas las recomendaciones para el urólogo en su práctica clínica. Puesto que la HGPIN es un hallazgo frecuente en la biopsia prostática y actualmente no existe una actitud clínica consensuada, es recomendable un esfuerzo en la comprensión de su significado clínico.

Objetivo

Sintetizar las principales características de la HGPIN y evaluar su relación con el CP. Justificar las variaciones de su incidencia y analizar el significado clínico actual de su detección en la biopsia prostática.

Material y métodos

Revisión de la literatura basada en la búsqueda y análisis de las publicaciones halladas en PubMed con las palabras «prostate» e «intraepithelial neoplasms».

Resultados

La tasa de detección de HGPIN se ha incrementado en la medida en que se ha aumentado el número de punciones realizadas en la biopsia prostática. Con los esquemas de biopsia actuales (10–12 punciones), la tasa de detección de CP en biopsias de repetición es similar en pacientes con y sin HGPIN aislada. Sin embargo, la multifocalidad de la HGPIN predice un mayor riesgo de detección de CP en la biopsia de repetición.

Conclusión

La detección de HGPIN es frecuente con los esquemas actuales de biopsia. Su relación genética con el CP es clara y su multifocalidad es el factor predictor de CP más importante.

Palabras clave:
Cáncer de próstata
Neoplasia intraepitelial prostática
Oncogénesis

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