Predictors for the progression to prostate cancer in patients diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation: a case–control study

Abstract Objective To explore the preoperative predictors of the progression to prostate cancer after diagnosing with highgrade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) in first prostate biopsy and compare the oncological outcomes of HGPIN and ASAP in second prostate biopsy. Methods Data from 175 patients who were diagnosed with HGPIN or ASAP in first prostate biopsy and received second prostate biopsy were retrospectively collected. Propensity-score matching was performed using six preoperative variables, and postoperative variables were compared between two groups. Results A total of 41 patients (23.4%) were diagnosed with prostate cancer in second biopsy. There were no significant differences in age, body mass index (BMI), prostate volume, ECOG performance status and first biopsy pathology between prostate cancer (PCa) group and non-PCa group. Preoperative serum PSA was significantly higher in PCa group than in no-PCa group (12.99 (IQR 6.56–31.31) vs. 7.18 (3.23–19.54) ml, p<0.001). Furthermore, PCa group had higher PI-RADS score of preoperative multiparameter magnetic resonance imaging (mpMRI) than non-PCa group (1 point 7.3% vs. 23.1%, 2 points 29.3% vs. 45.5%, 3 points 56.1% vs. 29.1%, 4 points 4.9% vs. 2.3%, 5 points 2.4% vs. 0%, P = 0.002). On univariable and multivariable analysis, preoperative serum PSA(OR 1.598, p<0.001) and PI-RADS score (OR 2.029, p = 0.025) (compared with low PI-RADS score) were independent predictors of progression to prostate cancer in second biopsy. Meanwhile, no statistically significant differences of second biopsy were observed between the HGPIN group and ASAP group about oncological outcomes (malignant rate, Gleason score, number of positive biopsy needles). Conclusions Preoperative serum PSA and PI-RADS score of preoperative multiparameter magnetic resonance imaging were independent predictors of progression to prostate cancer in second biopsy. Oncological outcomes of malignant second biopsy were similar although with different first biopsy pathologies (HGPIN or ASAP).