Introduction:
Precancerous prostate lesions are ones that have the potential to develop into cancer. Precancerous tissues comprise cells that have developed abnormalities due to DNA mutation. These prostate lesions are critical for understanding prostatic carcinogenesis and designing prospective prostate cancer chemopreventive treatments.
What Are the Precancerous Lesions of Prostate?
Precancerous lesions of the prostate, such as prostatic intraepithelial neoplasia (PIN), particularly high-grade PIN (HGPIN), and atypical small acinar proliferation (ASAP), have been discovered as precursor lesions to prostatic carcinoma. The PIN is the precancerous end of a morphologic range characterized by cellular proliferation within the prostatic ducts, ductules, and acini. Prostate intraepithelial neoplasia is also a precancerous lesion. Atypical small acinar proliferation (ASAP) is not synonymous with HGPIN; hence, the two terms should not be interchangeable. Neither HGPIN nor ASAP has the ability to metastasize. These tumors are found exclusively in the prostate gland.
1. Prostate Intraepithelial Neoplasia (PIN): This condition is commonly recognized as a precancerous prostate condition. Prostate intraepithelial neoplasia(PIN) can occur in any prostate section but is more frequently identified in the peripheral zone, typically where prostate cancer starts. The PIN can be classified according to its grade, with only a high-grade PIN being considered precancerous. However, even high-grade PIN may not progress to cancer. Three types of PIN were first proposed; however, only the names low-grade PIN (LGPIN) and high-grade PIN (HGPIN) are used.
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High-Grade PIN (HGPIN): HGPIN is characterized by structurally benign prostatic acini and ducts with atypical cells that exhibit prostate cancer-like morphologic, histochemical, immunohistochemical, and genetic alterations.HGPIN, on the other hand, does not penetrate the prostate glands' basement membrane.
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Low-Grade PIN (LGPIN): Low-grade PIN is thought to have a different clinical profile than a high-grade PIN. The majority of cases with LGPIN do not advance, and follow-up care for patients with LGPIN is identical to that for individuals without the PIN. The majority of pathologists no longer disclose the presence of LGPIN.
2. Proliferative Inflammatory Atrophy (PIA): This condition is described by unusually tiny cells in inflamed parts of the prostate. According to several types of research, PIA (proliferative inflammatory atrophy) may be connected with an increased risk of PIN and prostate cancer. Prostate cells seem smaller than normal in PIA, and the area exhibits symptoms of inflammation. Although PIA is not cancer, researchers believe that it may occasionally progress to high-grade PIN or directly to prostate cancer.
3. Atypical Small Acinar Proliferation (ASAP): ASAP causes gland cells to grow abnormally, and men who have it have a 40 % to 50 % greater risk of developing prostate cancer. ASAP refers to a set of lesions with different clinical importance (e.g., adenosis, atypical adenomatous hyperplasia, intraductal hyperplasia, and acinar atypical hyperplasia). Although some ASAP lesions mimic cancer and in many cases, focal carcinoma is present, cytologic, histochemical, and architectural atypia alone are unable to establish a conclusive diagnosis of cancer.
What Are the Symptoms of Precancerous Lesions of Prostate?
These lesions enlarge the prostate gland, constrict the urethra, and hence induce a variety of urinary symptoms, including the following:
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When urinating or ejaculating, there may be pain and a burning feeling.
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Frequent urination, particularly at night.
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Having difficulty initiating urine.
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Erectile dysfunction that occurs suddenly.
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Blood in urine or sperm.
How Are the Precancerous Lesions Diagnosed?
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A prostate biopsy can determine whether a patient has a high-grade PIN (HGPIN) or atypical small acinar proliferation (ASAP). Due to the fact that neither form of lesion creates symptoms on its own, no physical examination findings indicate the presence of PIN or atypical small acinar proliferation (ASAP).
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Regardless of the procedure used, Lidocaine is injected around the apex and base of the prostate, and Lidocaine gel is injected into the rectum. Antibiotics are routinely provided prophylactically (before the procedure) on the day of a prostate biopsy and frequently on the following day.
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Current biopsy techniques include targeted biopsy guided by MRI imaging, MRI and ultrasound fusion, and transperineal biopsies guided by MRI.
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Typically, during the biopsy, the doctor will examine the prostate using an imaging test such as transrectal ultrasonography (TRUS) or magnetic resonance imaging (MRI), or a 'fusion' of the two. A thin, hollow needle is immediately inserted into the prostate by the clinician.
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This is accomplished either through the rectum's wall (a transrectal biopsy) or through the skin between the scrotum and anus (an anus biopsy) (a transperineal biopsy). A tiny cylinder (core) of prostate tissue is removed when the needle is withdrawn. This procedure is performed numerous times. Typically, the doctor will obtain approximately twelve core samples from various areas of the prostate.
What Tests Are Done After Diagnosing Precancerous Lesions to Know the Chances of Getting Cancer?
If you are presented with any precancerous lesion, to know the chances of progressing to prostate cancer, some diagnostic tests like biopsy and prostate-specific antigen (PSA) tests are performed along with general physical examination.
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When HGPIN or ASAP are identified, the pathologist thoroughly examines tissue specimens for cancer indications, as these entities are usually detected in prostates containing prostate cancer cells. Indeed, because of this link, these lesions have come to be seen as noncancerous precursors to the development of true prostate cancer.
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PSA (Prostate-specific antigen ) Blood Test: PSA is a protein produced by cells in the prostate gland (both normal cells and cancer cells). PSA is primarily found in sperm, but a trace amount can also be found in the blood, and levels of PSA in the blood are measured in nanograms per milliliter (ng/mL).
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The chances of developing prostate cancer are more with the increase in PSA levels, and there is no definitive cutoff point for determining whether a man has or does not have prostate cancer. When deciding whether a man requires further testing, many doctors utilize a PSA cutoff of 4 ng/mL or above, while others may advocate starting at a lower level, such as 2.5 or 3.
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Biopsy: If the PSA blood test or other tests indicate that you may have prostate cancer, you will almost certainly require a prostate biopsy. A biopsy involves the removal of smaller sections of tissue samples of the prostate and their examination under a microscope. The primary method of diagnosing prostate cancer is with a core needle biopsy. Typically, it is performed by a urologist.
How Are the Results Evaluated After Diagnostic Tests?
For Prostate-Specific Antigen (PSA) Test: PSA values in the blood of most men without prostate cancer are less than four ng/mL.
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A level below four does not guarantee that a man is cancer-free.
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Men with a PSA with a score of 4 to 10 (often referred to as the "borderline range") have a roughly 1 in 4 percent chance of developing prostate cancer.
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If the level of PSA is greater than 10, the risk of developing prostate cancer is greater than 50 %.
Evaluation of Test Results for Biopsy: It may be challenging to confirm a diagnosis of HGPIN, ASAP, or prostate cancer. If the diagnosis is ambiguous, have another pathologist review the slides. In individuals with chronic or acute inflammation, or those who have received radiation therapy, these lesions may be difficult to diagnose.
Your biopsy samples will be submitted to a laboratory to be examined under a microscope to determine whether they contain cancer cells. Typically, it takes between one and three days to receive the results (in the form of a pathology report), but it can occasionally take longer. The results may be stated as follows:
1. Positive Report: Cancer cells were detected in biopsy samples.
2. Negative Report: No cancer cells were detected in biopsy samples.
3. Suspicious: An abnormality was observed, but it did not appear to be a malignancy.
How Do You Treat and Manage Precancerous Lesions?
Typically, therapy is not essential in individuals with a single focus on prostate-specific antigen (PIN), particularly high-grade pin (HGPIN). Treatment may be considered in patients with several areas of high-grade pin (HGPIN) or atypical small acinar proliferation (ASAP) on the initial biopsy or subsequent biopsies, as a cancer risk is 15 times greater in these patients than in those without these entities.
1. Pharmacologic Therapy: Unless several biopsy cores reveal HGPIN, drug therapy is typically not suggested for patients with high-grade pin (HGPIN) or atypical small acinar proliferation (ASAP).
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Therapy may be explored in patients with multiple lesions who have persistent results on repeat biopsies.
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High-grade pin (HGPIN) and atypical small acinar proliferation (ASAP) have been proven efficacious when treated with one of the 5-alpha reductase inhibitors, Finasteride or Dutasteride.
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These medicines are often taken for six to 12 months, followed by a prostate biopsy.
2. Monitoring: The PSA level and the results of the rectal prostate examination can help determine the necessity for additional biopsies. Although HGPIN and ASAP appear not to affect PSA levels, individuals with an increased PSA level associated with prostate size or a quickly growing PSA level should have follow-up biopsies at three or six months. A persistently increasing PSA level that doubles every 12 months or less would necessitate prostate biopsies regardless of the existence of PIN or ASAP.
Conclusion:
However, the presence of HGPIN or ASAP does not always indicate the existence of prostate cancer. At the same time, these symptoms may proceed to invasive cancer, HGPIN, and ASAP stay stable in many people for years and regress in others. Contact your physician immediately if you are found to have any signs of precancerous lesions to avoid the lesions turning into cancer.
