Use of Prostate-Specific Antigen Velocity to Follow Up Patients with Isolated High-Grade Prostatic Intraepithelial Neoplasia on Prostate Biopsy

Objectives: No consensus has been reached about the optimal follow-up for patients with an isolated finding of high-grade prostatic intraepithelial neoplasia (HG-PIN) on prostate biopsy. Early studies reported that approximately one half of men with HG-PIN were diagnosed with prostate cancer (CaP) within a few years. However, more recent studies, using extended biopsy protocols, have shown that HG-PIN may be less predictive of CaP on repeat biopsy in the short term. Thus, our objective was to identify the clinical factors that could help predict which men with isolated HG-PIN were at the greatest risk of subsequent CaP detection. Methods: In 190 men from a CaP screening study with an initial biopsy finding of HG-PIN, we compared the prostate-specific antigen velocity (PSAV) between patients who were later diagnosed with CaP and those who were not. Multivariate models were constructed for the ability to predict CaP detection. Results: The median PSAV was significantly greater in the men with HG-PIN who were subsequently diagnosed with CaP (P = 0.03). A PSAV threshold of 0.75 ng/mL/yr predicted which men with HG-PIN would ultimately be diagnosed with CaP (P = 0.007). On multivariate analysis, including PSAV, age, and initial PSA level, PSAV was the only significant predictor of subsequent CaP detection. Conclusions: Among the men with an isolated finding of HG-PIN on prostate needle biopsy, PSAV helps to identify those men who are subsequently diagnosed with CaP. Thus, we advocate the use of the PSAV to help guide the need for repeat biopsy in men with HG-PIN.