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High-grade prostatic intraepithelial neoplasia is a precancerous cellular change found in the prostate gland. It can be a predictor for future prostate cancer, indicating that the patient needs to attend regular followups to monitor the gland for signs of cellular changes. Early identification of cancer can assist with rapid treatment, which can improve patient outcomes; however, some patients may receive unnecessarily invasive testing and treatments for slow-moving cellular changes that could be unlikely to be fatal before the patient dies of an unrelated issue.
Doctors can recommend a biopsy of the prostate gland after noting swelling or a patient history of difficulty urinating and discomfort. It can be performed through the rectum with a needle aspiration procedure, or surgically, in which case the surgeon takes a section of the gland. A pathologist examines the sample to determine if it has signs of changes, which can be graded on the basis of how severe they are. High-grade prostatic intraepithelial neoplasia indicates that substantial changes have occurred.
Studies evaluating patients with some form of neoplasia in the prostate gland note that the chances of developing prostate cancer are highest for those who have high-grade prostatic intraepithelial neoplasia. It typically takes at least five years for cancer to manifest, and sometimes longer. When a pathologist makes this finding, the doctor may discuss it with the patient to determine the best course of action. This can depend on the patient’s age and general level of physical health.
One option is to recommend a series of recheck exams. The doctor can keep examining the prostate and collecting biopsy samples to evaluate. It is important to select new biopsy sites carefully to ensure that a good distribution of cells is provided for the pathologist. This increases the chances of spotting dangerous cellular changes indicating that prostate cancer has developed.
For patients who are very old or have underlying medical conditions that are likely to prove fatal, treatment for high-grade prostatic intraepithelial neoplasia may involve less aggressive action. A wait and see approach may be recommended to keep the patient as healthy and stable as possible, without specific action to address the prostate gland. People may prefer this option to invasive rechecks of the gland for signs of cancer that is likely to develop only at the end of their lives, and may never grow large enough to be fatal before the patient dies of something else.