<p><strong>In patients with multifocal HGPIN, clinicians may proceed with additional risk evaluation, guided by PSA/DRE and mpMRI findings. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>Relatively few studies on the risk of prostate cancer following an initial diagnosis of HGPIN have focused on multifocal HGPIN (e.g., HGPIN in <u>></u> 2 cores). Older reports suggest a higher risk of cancer detection for multifocal HGPIN (approximately 30% to 45%), compared to isolated HGPIN.<sup>246, 259, 267</sup> However, these studies lacked repeat biopsy with mpMRI and did not specify the detection of clinically significant prostate cancer. More recent data with repeat biopsy done with mpMRI guidance demonstrate that in approximately 25% of patients with previous multifocal HGPIN, serum PSA and/or DRE are normalized after the non-cancer bearing prostate biopsy.<sup>268</sup> The risk of GG2+ detection in repeat biopsies of patients with multifocal HGPIN is approximately 30%, which is not higher than in those without this finding.<sup>268</sup> In patients with persistent prostate cancer suspicion, the risk of detecting clinically significant prostate cancer in repeat prostate biopsies, based on PSA and DRE, is independent of the previous finding of HGPIN. Thus, a recommendation to repeat a prostate biopsy after HGPIN should be based on PSA and DRE evolution, and mpMRI findings. Due to a lack of data stating otherwise, repeat prostate biopsy should not be recommended solely because of a previous diagnosis of HGPIN, even if multifocal. As in the PSA screening setting, the use of SDM is highly recommended given the uncertainty involved.</p>