Testing and PIN

A prostate biopsy that reveals prostatic intraepithelial neoplasia (PIN) may leave men unsure of how to react. Although PIN is thought to be a pre-malignant lesion that has the potential to evolve into cancer, it is not cancer itself. But certain men with this finding require careful follow-up because sometimes a second biopsy will reveal a previously undiagnosed tumor. Approximately 9 percent of men who have a prostate biopsy in the United States will be diagnosed with high-grade PIN, which translates to approximately 115,000 men every year.

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There is controversy among experts as to the appropriate follow-up of men with high-grade PIN. Some studies have shown that men with high-grade PIN are at higher risk of having prostate cancer and should undergo a repeat biopsy. However, several well-designed studies suggest that men with a diagnosis of high-grade PIN have the same risk of prostate cancer as men who have no abnormal findings on a biopsy. If a man with high-grade PIN had a well-performed, extended biopsy that included sampling of the entire peripheral zone of the prostate, then a repeat biopsy is not mandatory. A reasonable follow-up plan would be a digital rectal examination and yearly or biennial testing of PSA levels.

Some evidence suggests that PIN lesions may be part of a multistep process that leads to invasive prostate cancer since PIN shares many of the genetic hallmarks of "true" prostate cancer. Men with high-grade PIN should continue to have their PSA levels checked and undergo periodic prostate exams. They should also keep their weight under control, exercise regularly, and eat a low-fat diet rich in fruits, vegetables, and fiber.