Pathologist Questions Prostate Cancer

Prostate pathology report

What is high grade PIN that I see on my pathology report?

11 Answers

Pre-cancerous lesion. No cancer yet however can progress to cancer.
High grade prostatic intraepithelial neoplasia is a precursor lesion that is very strong associated with the later development of, or concurent finding of prostatic adenocarcinoma (prostate cancer). It does not represent cancer itself, but is a early or pre-cancer. With time, this finding is often associated with or develops into cancer. They are graded into low, intermediate and high grade, and it is only the High grade PIN that is usually associated with cancer.
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American Cancer Society's web page explains this very well and is very much reflective of the current understanding and my personal view about "high grade PIN" at this point in time.

Here is the write up:

PIN begins to appear in the prostates of some men as early as their 20s. Almost half of all men have PIN by the time they reach 50. High-grade PIN is considered a pre-cancer of the prostate because it may turn into prostate cancer over time.
Low-grade PIN in general should not be on a biopsy report, as it has no significance. If I have high-grade PIN, does that mean it will turn into prostate cancer?

No. In most cases, high-grade PIN will not turn into cancer over the next several years. Still, the risk of getting cancer later is higher if high-grade PIN is found in more than one biopsy core. What does it mean if the report says that only one of my biopsy samples (cores) shows high-grade PIN, but it does not mention carcinoma (cancer)?

It means there is no cancer in this biopsy sample. In most cases, even a repeat biopsy will not show cancer. Do I need a repeat prostate biopsy over the next year or several years after a diagnosis of high-grade PIN?

In most cases, the chance of finding cancer is low, so a repeat biopsy done soon after the diagnosis of high-grade PIN is not useful. However, some patients do have a higher risk, such as men with multiple cores showing high-grade PIN. Discuss if and when you have a repeat biopsy with your doctor.
High grade PIN indicates the presence of precancerous foci in the biopsy. Patients with high grade PIN require a closer follow up by their urologist, which may include, repeat physical examination, repeat serum PSA level evaluation and repeat biopsies.
High grade PIN is a precancerous lesion
of prostate glands.
If you have it on the biopsy you need to follow up.
You may have an increased risk of prostate cancer.
Most cancers of the prostate develop from glands of the prostate when they begin to abnormally grow or "invade" into other prostate tissues. High grade PIN is a change in the prostate glands that is recognized as abnormal, but it remains contained within the glands and hasn't "invaded" the other prostate tissues. In other words, it is like a pre-cancer. High grade PIN can change into cancer over time, but it does not necessarily do that. This means you are at increased risk of developing prostate compared to a man without it. This is why you should follow-up with your urologist at recommended intervals.
High grade PIN (prostatic intraepithelail neoplasia) is a pre-cancerous condition. It means that there are abnormal cells in the prostate that put you at higher risk for developing cancer. You DO NOT have cancer at the present time. It also means that you should have periodic assessments done with your physician, who should advise you on the frequency of these assessments
PIN is the short for "prostatic intraepithelial neoplasm" . It is a condition seen in prostate biopsies and it is the pathologist who sees it see under the microscope. The cells are funny-looking or atypical, but not consider to be cancerous, PIN has been considered a sort of precursor for prostate cancer.
PIN itself does not appear to invade the surrounding normal tissue.
PIN that it is most likely just that precursor cells that are not cancer.

If high-grade PIN is found in multiple cores or if it is present in tissue from both sides of the prostate, right and left, then a repeat biopsy will be recommended.
When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called *a pathologist*. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy. What does it mean if my biopsy report mentions the word core? The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a *core*. This is often repeated several times to sample different areas of the prostate. Your pathology report will list each core separately by a number (or letter) assigned to it by the pathologist, with each core (biopsy sample) having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what is going on with you. What is prostatic intraepithelial neoplasia (PIN)? In this condition, there are changes in how the prostate gland cells look under the microscope, but the abnormal cells don't look like they are growing into other parts of the prostate (like cancer cells would).
PIN is prostate intraepithelial neoplasia. There are two grades, low grade and high grade. Low grades are usually left alone. High grade is the stage before the cancer (pre-malignant). The cells that are growing faster, are disorganized and are within the tubules or glands and have not invaded into the surrounding stroma of prostate.
You have just seen a small cluster of weed growing in your favorite collection of flower beds, you have decided to ignore it and see what happens, a few days later you see a few more of these patches within the collection of the flower beds, and you still ignore it, several months and sometimes years later, the weed has now spread all over your back yard and garden, and it has become a nightmare to have it all eradicated!
PROSTATE INTRA-EPITHELIAL NEOPLASIA IS the weed you saw in the small garden patch, but it has not spread as yet, or let's say, there is cancer within the prostate and they mention PIN, it means they have identified the original early cancer that was confined to the glands of the prostate in the midst of this cancer that has broken through. Generally, if the core biopsies only show a PIN, there is no way to tell if this is going to become cancer and break out or be confined to the gland.The PIN cells look like the cancer cells, but have not broken through as yet. This is not the same in the Breast called DCIS, where if present, there will be surgical action taken to remove the whole area in its entirety.