High grade prostatic intraepithelial neoplasia

by Trevor A. Flood, MD FRCPC
August 20, 2024

Background:

High grade prostatic intraepithelial neoplasia (HGPIN) is a condition in which the cells that line the ducts and glands of the prostate gland show abnormal changes. These changes are not cancerous, but they are considered precancerous, meaning they may develop into prostate cancer over time. HGPIN is often detected in prostate biopsies, which are usually performed to investigate the possibility of prostate cancer.

Does high grade prostatic intraepithelial neoplasia mean cancer?

No, HGPIN is not a type of prostate cancer. As a result, definitive treatment, such as surgery or radiation therapy, is not required for patients with HGPIN.

What are the symptoms of high grade prostatic intraepithelial neoplasia?

HGPIN typically does not cause any symptoms on its own. It is usually discovered incidentally during a biopsy performed for another reason, such as evaluating elevated prostate-specific antigen (PSA) levels or abnormal findings on a digital rectal exam (DRE). Because HGPIN itself does not produce symptoms, patients may not be aware of its presence until they undergo a biopsy.

What causes high grade prostatic intraepithelial neoplasia?

The exact cause of HGPIN is not fully understood. However, it is thought to result from genetic mutations and changes in the prostate cells over time. Risk factors for developing HGPIN are similar to those for prostate cancer and include advancing age, family history of prostate cancer, and certain genetic predispositions. Environmental factors such as diet and exposure to certain chemicals may also play a role, although their exact contribution is unclear.

What is the risk of developing prostate cancer after a diagnosis of high grade prostatic intraepithelial neoplasia?

The presence of HGPIN is considered a marker for an increased risk of developing prostate cancer in the future. Studies suggest that men diagnosed with HGPIN have a higher likelihood of developing prostate cancer compared to men without this diagnosis. The exact risk varies, but some studies estimate that approximately 20-30% of men with HGPIN may develop prostate cancer over time. For this reason, patients diagnosed with HGPIN are often monitored closely with regular PSA testing and follow-up biopsies to detect any progression to cancer.

What is the recommended treatment for high grade prostatic intraepithelial neoplasia?

Experts are divided on the type of medical follow-up recommended when HGPIN is detected on biopsy. It is generally accepted that other factors should be evaluated when and if a repeat biopsy should be performed.  Talk to your doctor to determine the best management strategy for you.

Microscopic features of high grade prostatic intraepithelial neoplasia

HGPIN is diagnosed after tissue from the prostate is examined under the microscope by a pathologist. The abnormal cells in HGPIN are located in the glands and ducts of the prostate. Unlike cancer cells, the abnormal cells in HGPIN are still separated from the surrounding tissue by a thin barrier. When viewed under the microscope, the abnormal cells are larger than normal prostate cells, their nuclei (the part of the cell that holds the genetic material of the cell) are hyperchromatic (darker), and prominent round structures called nucleoli can be seen in the center of the nucleus.

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