Prostatic Intraepithelial Neoplasia ("PIN")

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KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 8/1/2008 10:29 PM (GMT -6)   
My Urologist called today and said that the pathology report indicated that Prostatic Intraepithelial Neoplasia ("PIN") was found in my biopsy tissue.  He went on to say that this will require more close care but did not indicate cancer.
 
Has anyone here been told they have PIN???  The Prostate Cancer Research Institute says it is "A premalignant lesion".
 
Here is what wikipedia says:
 
       Prostatic Intraepithelial Neoplasia ("PIN")
Diagnosis
PIN is frequently found by pathologists in tissue samples from needle biopsies taken via the rectum, or in surgically removed prostate tissue. PIN can be found after transurethral surgery for benign prostatic hyperplasia (the increase in size of the prostate in middle-aged and elderly men), or after complete removal for prostate cancer (a procedure called radical prostatectomy). Blood tests for prostate specific antigen, digital rectal examination, ultrasound scanning of the prostate via the rectum, fine needle aspiration or medical imaging studies (such as magnetic resonance imaging) are not useful for diagnosing PIN.

Histopathology
Microscopically, PIN is a collection of irregular, atypical epithelial cells. The architecture of the glands and ducts remains normal. The epithelial cells proliferate and crowding results in a pseudo-multilayer appearance. They remain fully contained within a prostate acinus (the berry-shaped termination of a gland, where the secretion is produced) or duct. The latter can be demonstrated with special staining techniques (immunohistochemistry for cytokeratins) to identify the basal cells forming the supporting layer of the acinus. In prostate cancer, the abnormal cells spread beyond the boundaries of the acinus and form clusters without basal cells. In PIN, the basal cell layer is disrupted but present.
PIN can be subdivided into different stages, based on the level of cell atypia. PIN was formerly classified as PIN 1, 2 or 3, in order of increasing cell irregularities. Nowadays, PIN 1 is referred to as low grade PIN, and PIN 2 and PIN 3 are grouped together as high grade PIN.[1] Only high grade PIN has been shown to be a risk factor for prostate cancer. Because low grade PIN has no significance and does not require repeat biopsies or treatment, it is not mentioned in pathology reports. As such, PIN has become synonymous with high grade PIN.
Because it is thought to be a premalignant state, PIN is often considered the prostate equivalent of what is called carcinoma in situ (localized cancer) in other organs. However, PIN differs from carcinoma in situ in that it may remain unchanged or even spontaneously regress.
Several architectural variants of PIN have been described, and many cases have multiple patterns. The main ones are tufting, micropapillary, cribriform, and flat. Although these different appearances may cause confusion with other conditions, they have not been found to be of clinical importance. Rarer types are signet-ring-cell, small-cell-neuroendocrine, mucinous, foamy, inverted, and with squamous differentiation.[2]

Relation to prostate cancer
There are several reasons why PIN is the most likely prostate cancer precursor.[2] PIN is more common in men with prostate cancer. High grade PIN can be found in 85 to 100% of radical prostatectomy specimens,[3] nearby or even in connection with prostate cancer. It tends to occur in the peripheral zone of the prostate. With age, it becomes increasingly multifocal, like prostate cancer. Molecular analysis has shown that high grade PIN and prostate cancer share many genetic abnormalities.[4] This has been confirmed in a transgenic mouse model.
The risk for men with high grade PIN of being diagnosed with prostate cancer after repeat biopsy has decreased since the introduction of biopsies at more than six locations (traditional sextant biopsies).[2]

Treatment
PIN does not require specific therapy, but close follow-up with additional biopsies is warranted. The exact timing of repeat biopsies remains an area of controversy. Studies are ongoing to evaluate the usefulness of diet modification, supplements or hormonal therapy for high grade PIN.
I guess I have to be scared again!!!  UUUgggghhhh........
 
 
Jim
 
 


I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer.
Father 74 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
06/04/08 - At physical DRE normal, PSA test returns 4.4
06/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.
07/11/08 - PSA test returns 4.1. Scheduled the Stereotactic Transperineal Prostate Biopsy for 7/21
07/21/08 - Had the biopsy.  Not so bad but sore on day 2. Back to work tomorrow
07/23/08 - Pathology comes back NO CANCER DETECTED!
08/01/08 - Urologist calls and says Prostatic Intraepithelial Neoplasia ("PIN") was foind in my biopsy

Post Edited (KC9AOP) : 8/1/2008 9:33:01 PM (GMT-6)


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 8/2/2008 5:55 PM (GMT -6)   

 " Studies are ongoing to evaluate the usefulness of diet modification, supplements or hormonal therapy for high grade PIN."

USEFULNESS OF DIET MODIFICATION" : While it might be anecdotal in relation to PIN, it's obvious that lifestyle improvements can only help health in general, strengthen the immune system and hopefully reduce the probability of PC.  Asian and Japanese men on  traditional diets have relatively low instances of PC. 

HORMONAL THERAPY" : It would be difficult to mount a logical argument to justify Hormone therapy as a "treatment" for PIN.

For anyone interested in hormone therapy I always suggest the book on hormone traetment and diet by Dr Charles Myers, who has also published a book devoted to diet.

I had a  biopsy in 2004 that indicated high grade PIN and one positive G6 sample.

2006 biopsy was all clear.

Biopsy readings are subjective: what looks like cancer to one person can look more normal to another.

Personally I'd be improving lifestyle diet and supplements, and continue regular PSA testing, incluce a "freePSA" test.

 

 

 

 
 

KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 8/2/2008 10:53 PM (GMT -6)   
Selmer said...
KC9AOP said...
He went on to say that this will require more close care but did not indicate cancer.

I guess I have to be scared again!!! UUUgggghhhh........


Jim, Look, I know you wanted some clean line........cancer, no cancer.........but for most men, from age 40 to 90 the status of the prostate is really a continuum. At 40 very few will have PCa and by 90 a fairly high percentage will have PCa although it may not diagnosed in all of them.

People find it odd when I say I just assume I have micro, or more, PCa currently even though I have not been biopsied, and still have a fairly low PSA result most of the time. Now or 10 years from now, if you took out my prostate and sliced it and diced it I'm sure you'd find some PIN as well as some micro Gleason 6 spots.
I'm still hoping I never have to have that done but I don't make believe some micro, or more, spots are not there.

So, your prior elation need not turn back to fear. You just have to keep a steady eye on it and do all you can to create the environment where any potential transformation or growth "might" be slowed or halted.
Even if you get really into doing that with all the steps possible, you have no way of knowing if your efforts will be of any value at all. You do what you can and remain vigilant with your urologist.

You are kind of in a "watchful waiting"-----or early era "active surveillance" ...... but prior to any diagnosis.

BTW, I don't think there is any study showing that all PIN eventuates in a diagnosis of PCa. You might read up on the data about that point.
So you're back to keeping an eye on the old prostate and, if motivated, doing all the changes that "may" have some effect on the future course of your particular situation.

At least you aren't needing to think about treatment at this point. Think about that positive aspect.

Selmer

Thanks Selmer,
 
Again you have helped me slow down my panic...
 
When I got the all clear from the oncologist I thought it was just that.  He never even mentioned PIN to me.  My Urologist called and said that PIN was on the biopsy report and we should be sure to schedule an appointment.  This was a voice mesage so I had no chance to ask any questions.  He DID say that this is NOT cancer but is information that we need to use for on-going care.
 
Since I've had a lot a cancer nightmares in my life with father and sister I am emotionally shell shocked.  Just about anything would set me off about now.  I really don't want to have to face this as I've seen it ravage people very close to me.  The relief I felt at the all clear was palpable.  Now it is greatly diminished to be sure.
 
I'll do what I did when this whole journey started.  In about 2 weeks I'll know more about PIN than most and will be sharing what I find.  At least the information will keep me feeling more in control.
 
Jim
 

I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer.
Father 74 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
06/04/08 - At physical DRE normal, PSA test returns 4.4
06/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.
07/11/08 - PSA test returns 4.1. Scheduled the Stereotactic Transperineal Prostate Biopsy for 7/21
07/21/08 - Had the biopsy.  Not so bad but sore on day 2. Back to work tomorrow
07/23/08 - Pathology comes back NO CANCER DETECTED!
08/01/08 - Urologist calls and says Prostatic Intraepithelial Neoplasia ("PIN") was found in my biopsy 


KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 8/4/2008 10:30 PM (GMT -6)   
Here is more on PIN.

There used to be 3 grades of PIN numbered 1 - low, 2 - medium and 3 - high. Now there are only 2 grades named low and high. If you have a pathology report that mentions PIN then you have high grade PIN. 85% to 100% of men with PCa have PIN as well.

PIN is a mutated cell condition in which the neucleus of the cells are abnormal and the cell replication is faster than normal cells. The fast replicating cells stack on each other and crowd the ducts and may cause inflamation. The difference between cancer and PIN is that PIN affected cells still have a basal feature and cancer does not. Since I'm not a doctor that's about as close as I can come to describing what I've read so far.

When a study was done of re-biopsy of men with PIN, the control group (with no PIN) had a 13% occurance of PCa detection. Those with PIN had a 38% occurance of PCa detection. It seems that there is no agreed upon therapy to defeat PIN. Apparently radiation and hormone therapy can cause it to reverse but there is no clear medical protocol for anything curative. I believe that the jury is out on the effacacy of PIN as an indicator of impending PCa. Some articles from the Journal of Urology state that there is a clear causal relationship between PIN and PCa. Others say the causative relationship is not so clear.
 
Here is a sample of what I have been finding in my research:
 

PIN and prostatic carcinoma foci have a similar proportion of genetic changes, but foci of carcinoma usually have more alterations. This supports the hypothesis that PIN is the most likely precursor of prostatic carcinoma. The most common genetic alterations in PIN and carcinoma are: (1) gain of chromosome 7, particularly 7q31; (2) loss of 8p and gain of 8q, and (3) loss of 10q, 16q and 18q. Inactivation of tumor suppressor genes and/or overexpression of oncogenes in these regions may be important for the initiation and progression of prostate cancer.

Conclusions: FISH is a useful technique to determine genetic relationships between cancer and its precursors. PIN and prostatic carcinoma foci have a similar proportion of genetic alterations, suggesting that PIN is often a precursor of prostatic carcinoma. Genes on chromosomes 7, 8, 10, 16 and 18 may play an important role in both initiation and progression of prostatic carcinoma.

Long and short it seems that I will have to have another biopsy in 3 to 6 months if the not-so-standard standard is followed. IF PCa is not detected, then one biopsy per year, every year until PCa is detected. This could take 10 or more years. In few cases PCa is never developed. A close watch with bi-annual DRE and PSA tests are standard for follow up for any man with PIN.

As I gather more info I will post.

Jim


I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer.
Father 74 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
06/04/08 - At physical DRE normal, PSA test returns 4.4
06/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.
07/11/08 - PSA test returns 4.1. Scheduled the Stereotactic Transperineal Prostate Biopsy for 7/21
07/21/08 - Had the biopsy.  Not so bad but sore on day 2. Back to work tomorrow
07/23/08 - Pathology comes back NO CANCER DETECTED!
08/01/08 - Urologist calls and says Prostatic Intraepithelial Neoplasia ("PIN") was found in my biopsy 

Post Edited (KC9AOP) : 8/4/2008 9:54:01 PM (GMT-6)


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 8/6/2008 6:20 AM (GMT -6)   
Great to know you don't have any major problems to worry about.
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