High Grade PIN action plan
I'm a 50 year old man that had a PSA reading of 4.5 in a recent blood test/physical. Since former measurements were in the 2.4 range, I was referred to a specialist. In the urologist appointment, no DRE or repeat bloodwork was done. They simply said I needed a biopsy. The 10 needle TRUS biopsy revealed HGPIN and now they want to do a saturation biopsy.
In the initial appointment, I stated that I recently had a month or so of symptoms of prostatitus (about 3-4 weeks prior to the elevated PSA test, but they did not seem to feel this was significant data point. Those symptoms vanished as soon as they came on, but I have read that inflammation can give a false diagnosis of HGPIN sometimes.
Should I have first been treated for an infection, or is this process typical, given my relatively young age?
Thanks.
Most urologists would agree that an initial evaluation should always biopsy.
High grade PIN is associated with a fairly high risk of developing adenocarcinoma within 5 years. The real controversy here however is the use of the saturation biopsy to detect low levels of malignancy within the prostate. Saturation biopsies have been reported to increase the detection rate of prostate cancer. Given that prostate cancer is usually a slow growing cancer, many urologists would favor close follow-up in 3-6 months. Part of the decision process of whether to proceed with saturation biopsies would depend on how extensive the PIN was in the original biopsies.
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