Prostatic Intraepithelial Neoplasia
A review article on prostatic intraepithelial neoplasia, the most likely precursor of prostate cancer.
David G. Bostwick, M.D., M.B.A.

Introduction

High-grade prostatic intraepithelial neoplasia (PIN) is now accepted as the most likely pre-invasive stage of adenocarcinoma, a decade after its first formal description. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeat biopsy for concurrent or subsequent invasive carcinoma. The only method of detection is biopsy; PIN does not significantly elevate serum PSA concentration or its derivatives and cannot be detected by ultrasound. Most studies suggest that most patients with PIN will develop carcinoma within ten years. PIN is associated with progressive abnormalities of phenotype and genotype that are similar to cancer rather than normal prostatic epithelium, indicating impairment of cell differentiation with advancing stages of prostatic carcinogenesis. Androgen deprivation therapy decreases the prevalence and extent of PIN, suggesting that this form of treatment may play a role in chemoprevention.

Summary

High grade PIN is the most likely precursor of prostatic adenocarcinoma, according to virtually all available evidence. PIN is associated with progressive abnormalities of phenotype and genotype which are intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. There is progressive loss of some markers of secretory differentiation, whereas other markers show progressive increase.

The clinical importance of recognizing PIN is based on its strong association with prostatic carcinoma. PIN has a high predictive value as a marker for adenocarcinoma, and its identification in biopsy specimens of the prostate warrants further search for concurrent invasive carcinoma. Studies to date have not determined whether PIN remains stable, regresses, or progresses, although the implication is that it can progress. Androgen deprivation therapy decreases the prevalence and extent of high grade PIN, suggesting a role in chemoprevention.

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