To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies.
A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and repeat biopsy within one to three years was analysed. Pre-repeat mpMRI and guided biopsies to suspicious lessions (PI-RADS ≥3) and/or and systematic biopsies were performed. Persistent PCa suspicion, defined as sustained serum PSA over than 4 ng/ml and/or abnormal DRE, was present in 248 men (84.6), while not in 45 men (15.4%). A control group of 190 men who had no previous HGPIN, ASAP, or PINATYP being scheduled to repeat biopsy due to persistent PCa suspicion was also analysed. csPCa was considered when the grade group was ≥2.
In the subset of 45 men with isolated HGPIN, in whom PCa suspicion dissapeared, only one csPCa (2.2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34.7% of men with persistent PCa suspicion and previous HGPIN, while in 28.4% of those without previous HGPIN, p =0.180. iPCa was detected in 12.1% and 6.3% respectively, p =0.039. Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN, OR: 1.369 (95%CI: 0.894-2.095), p =0.149; however, it increased the risk of iPCa detection, OR: 2.043 (95CI: 1.016-4.109), p =0.006.
The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.

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