<p><strong>In patients with focal (one core) HGPIN on biopsy, clinicians should not perform immediate repeat biopsy. (<em>Moderate Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>The risk of cancer detection following a diagnosis of HGPIN has evolved. Early reports that utilized less than 12-core systematic sampling often found a high risk of undetected prostate cancer.<span><sup>257, 258</sup></span> However, contemporary studies indicate a 20% to 30% risk of any cancer detected (not just high-grade) in subsequent biopsies,<sup>246, 259-265</sup> which is the same risk following an initial benign biopsy. Even when repeat biopsy is performed, the risk of GG2+ carcinoma is relatively low (~10%).<sup>259, 261, 262, 264, 265</sup> As such, immediate repeat biopsy is not recommended for patients with a diagnosis of focal HGPIN on initial biopsy.<sup>266</sup> Nonetheless, routine follow-up is warranted, which may include mpMRI and/or additional biomarkers (<strong>see Statements 25 and 30</strong>). Patients with a diagnosis of HGPIN in the setting of other biopsy cores showing invasive prostate cancer should be managed in accordance with the definitive carcinoma component.<strong> </strong></p>