Prevalence of Isolated “Pre-Malignant” Lesions on Prostate Biopsy in a Racially Diverse Community Screened Cohort

Abstract

Objective: We investigated rates of prostate cancer (PCa), high-grade prostatic intraepithelial neoplaisa (HGPIN) and atypical small acinar proliferation (ASAP) in a multiethnic cohort. Methods: We evaluated prostate biopsy outcomes in men enrolled in the San Antonio Center of Biomarkers of Risk for prostate cancer (SABOR) prospective, observational study. PCa-free men underwent annual PSA testing over nearly 14 years with biopsies based on community standards. We investigated biopsy outcomes with a special interest in rates of cancer, HGPIN, and ASAP. Results: We identified 975 prostate biopsies in 801 subjects from 3/1/2001 to 1/9/2014. PCa, HGPIN, or ASAP was encountered in 28.8% (281/975), 10.1% (98/975), and 5.2% (51/975) of prostate biopsy specimens, respectively. The most significant risk factor for a PCa diagnosis was African American race (OR 5.0, 95% CI: 2.2 - 11.4, p < 0.001). HGPIN and ASAP occurred more commonly in association with PCa (both p < 0.001). We identified 57% (24/42) of men diagnosed with a “pre-malignant” lesion on prostate biopsy and had a subsequent biopsy. Of those only 8% (2/24) were diagnosed with prostate cancer (both Gleason 3 + 3) within 1 year of the initial biopsy. Conclusion: We note a 5-fold increased risk of PCa for African American men. The incidence of HGPIN and ASAP are consistent with previously reported incidence. If diagnosed in isolation, repeat biopsy within one year could be delayed or eliminated as it may not change prostate cancer outcomes.