Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0282612 (PIN)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prostate-specific antigen is a kallikrein-like serine protease that is produced exclusively by the epithelial cells of all types of prostatic tissue, benign and malignant. Physiologically, it is present in the seminal fluid at high concentration and functions to cleave the high molecular weight protein responsible for the seminal coagulum into smaller polypeptides. This action results in liquefaction of the coagulum. Prostate-specific antigen is also present in the serum and can be measured reliably by several different assays. Although the protein is prostate-specific, it is not prostate-cancer-specific. As a result, benign conditions such as benign prostatic hyperplasia, prostatitis and infarction, as well as prostatic intraepithelial neoplasia, can be associated with elevated serum levels of prostate-specific antigen. Approximately 25% of men with benign prostatic hyperplasia have an elevated serum value of prostate-specific antigen, whereas 35% to 40% of patients with organ-confined prostate cancer have a level within the reference range. Prostate-specific antigen can identify some cancers not detectable by digital rectal examination; alternatively, this examination can identify cancers not detectable from the serum prostate-specific antigen concentration. Thus, the most complete evaluation of the prostate gland is achieved when both the prostate-specific antigen value and the digital rectal examination are used. The density and the rate of change of serum prostate-specific antigen are new concepts to improve the ability of prostate-specific antigen to detect early prostate cancer. Preliminary results are encouraging, but additional studies are required to determine the true usefulness of these new variables. Thus, in 1992, determination of the prostate-specific antigen value is a valuable new tool for the practicing physician and will be instrumental in our campaign to diagnose clinically significant prostate cancer at an early, curable stage.
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PMID:Prostate-specific antigen and diagnosing early malignancies of the prostate. 128 95

Androgen ablation using hormonal manipulation is used extensively in metastatic prostate cancer; however, its use in localized disease combined with surgical extirpation of the gland has not been thoroughly and systematically investigated. The rationale for neoadjuvant therapy stems from the demonstrated effectiveness of androgen ablative therapy in metastatic disease and the high rate of "positive" surgical margins, especially in patients with Stage B2 disease. In addition, the essentially anecdotal clinical report of Scott and Boyd [1], using endocrine therapy plus radical prostatectomy in patients with Stage C disease, gives 15 year survival results comparable to those obtained by Jewett [2] in Stage 1 patients treated by radical prostatectomy. Finally, experimental observations in the androgen-sensitive mammary tumor (Shionogi) lend support to the concept of neoadjuvant hormonal manipulation. A pilot study of neoadjuvant endocrine therapy in 55 patients treated at Memorial Sloan-Kettering Cancer Center with 3 months of diethylstilbestrol (DES) (3 mg/day) prior to radical prostatectomy indicates marked reductions in prostate-specific antigen (PSA), although persistent evidence of adverse local tumor features was common. Some patients, however, exhibited evidence of significant downstaging. Whether or not any alteration in disease progression will accrue from demonstrated local downstaging is, of course, uncertain. However, clinical and laboratory effects of such treatment may provide a means for correlation with subsequent tumor behavior, and may prove useful in treatment decisions. Additionally, a decrease in the number of foci of grade 3 prostatic intraepithelial neoplasia (PIN-3) was noted in a small number of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neoadjuvant hormonal manipulation: a strategy for chemoprevention trials. 128 66

Acid phosphatase and prostate-specific antigen are extremely useful markers for the management of patients with prostatic carcinoma. Prostatic acid phosphatase, because of its relatively low sensitivity and specificity, as well as analyte instability and diurnal variability, is unsuitable for prostate cancer screening. Improved performance characteristics, stability, the lesser diurnal variation, and the association of elevated prostate-specific antigen with prostatic intraepithelial neoplasia make prostate-specific antigen possibly a better candidate for early detection of this common malignancy. Further investigations in this area are clearly indicated before we can recommend screening with prostate-specific antigen.
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PMID:Laboratory studies for the detection of carcinoma of the prostate. 169 41

Prostatic intraepithelial neoplasia (PIN) is a putative premalignant change in the human prostate. Previously, the spatial association of PIN with invasive carcinoma has been described in the study of total prostatectomies. PIN is frequently recognized in prostate needle biopsy specimens in which no carcinoma is apparent. To further define the potential significance of PIN, we performed repeat ultrasound-guided prostate needle biopsy in 21 men who had PIN identified on prostate biopsy performed because of an abnormal finding on digital rectal examination. Twelve patients (57%) had carcinoma identified on their second procedure including all who had intermediate- and high-grade PIN on the initial procedure. Prostate-specific antigen correlated with PIN grade and carcinoma on the secondary procedure, although this did not achieve statistical significance. Men with PIN on prostate needle biopsy should undergo repeat sampling to exclude missed carcinoma.
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PMID:Significance of prostatic intraepithelial neoplasia on prostate needle biopsy. 171 4

Prostate-specific antigen (PSA) is a sensitive and specific serum marker for monitoring disease activity in men with prostatic carcinoma. Despite reports of elevation of levels of this analyte in men with benign prostatic hyperplasia, no information is available correlating the serum levels with the actual prostatic abnormalities in men having prostatectomy for presumed benign disease. In the present investigation, the authors compared preoperative serum PSA levels with prostate disease in 81 men with bladder outlet obstruction. Five pathologic groups were found: incidental high-grade carcinoma (n = 3), low-grade carcinoma (n = 11), acute inflammation (n = 16) with or without chronic inflammation, Prostatic intraepithelial neoplasia (PIN) (n = 25), and benign hyperplasia (n = 26). Serum PSA levels were significantly elevated in both low- and high-grade carcinoma, acute inflammation, and PIN when compared with the patients with benign hyperplasia with and without chronic inflammation. Within the four groups with elevated levels, use of PSA levels could separate only the high-grade cancer patients who were subsequently shown to have metastatic disease. Only one patient with simple hyperplasia had PSA levels in the abnormal range.
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PMID:Serum prostate-specific antigen and prostate pathology in men having simple prostatectomy. 248 63

New as well as standard techniques for the detection and diagnosis of early prostate cancer have been described. These include the use of digital rectal examination, prostate-specific antigen, transrectal ultrasound, prostatic acid phosphatase, the Biopty gun, and cell ploidy, as well as the diagnosis of premalignant lesions of the prostate, such as prostatic dysplasia or, more appropriately, prostatic intraepithelial neoplasia. All of these innovations may enhance our ability to diagnose and follow patients with early prostate cancer. Full documentation and evaluation of long-term (15 to 20 years) follow-up, however, are needed to determine whether these new techniques will make a difference in the ultimate morbidity and mortality of prostate cancer in the United States. In the meantime, however, the use of these new diagnostic tools should not be avoided. We must advance with technology, and as the technologies grow and develop we should increase our understanding about the utility of each of these new tests and combine them with the older standard tests that have served us well for many years.
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PMID:The role of new modalities in the early detection and diagnosis of prostate cancer. 248 15

Prostatic intraepithelial neoplasia (PIN) is a putative premalignant lesion of the prostate gland. PIN has been demonstrated to share morphologic and phenotypic similarities to invasive carcinoma of the prostate. In addition, PIN is spatially related to invasive carcinoma and occurs with greater frequency in men whose prostates harbor carcinoma. Prostate-specific antigen (PSA) is a glycoprotein produced by the prostatic epithelium. For PSA to be detected in the serum, it must traverse several tissue layers to reach the circulatory system. PSA levels associated with PIN are intermediate between those of benign and malignant prostate tissue. Spatially associated occult carcinoma, disruption of the basal cell layer, and increased vascularity may account for elevated PSA values in PIN.
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PMID:Prostatic intraepithelial neoplasia and prostate-specific antigen. 750 83

Atypical adenomatous hyperplasia (AAH) of the prostate is a microscopic proliferation of small glands that may be mistaken for adenocarcinoma. The extent and multicentricity of this histopathologic lesion have not been fully defined, and the spatial relationship with carcinoma has not been described in whole-mount surgical specimens. We sought to determine whether the extent and zonal location of AAH is related to prostate cancer by evaluating 217 totally embedded radical prostatectomy specimens with cancer. All but 17 patients had clinically localized cancer, and none had received preoperative therapy. The number of foci and volume of AAH were measured using a grid-counting method; proximity to cancer was recorded as either less than or equal to 2 mm from cancer or greater than 2 mm from cancer. AAH was identified in 23.0% of cases and was more frequent in the transition zone (19.8% of cases) than in the nontransition (peripheral and central) zone (6.0%). It was found within 2 mm of cancer in 34% of cases of AAH, including 30% of cases in the transition zone and 31% cases in the nontrasition zone. The number of foci of AAH in the transition zone was always greater than that in the nontransition zone, regardless of whether it was within 2 mm of cancer or more than 2 mm from cancer. AAH was frequently multicentric (46% of cases), especially in the transition zone (47% of transition zone cases) compared with the nontransition zone (23% of nontransition zone cases). The mean volume of AAH was 0.029 cc (range, 0-1.29 cc) and was much higher in the transition zone than the nontransition zone, regardless of whether it was within 2 mm of cancer or more than 2 mm from cancer. In cases of AAH within 2 mm of cancer, the volume was lower than in cases more than 2 mm from cancer; this was true regardless of zonal location. AAH was more common in older patients and in those with greater prostatic weight, higher prostatic volume, greater percentage of nodular hyperplasia, greater volume of cancer, greater percent of Gleason patterns 4 and 5 cancer, higher volume of prostatic intraepithelial neoplasia, and higher serum prostate-specific antigen level. There was no correlation of number of foci of AAH or volume of AAH with pathologic stage, seminal vesicle invasion, Gleason primary pattern or score, nuclear grade, perineural invasion by tumor, or DNA ploidy. Our results indicate that AAH is usually found iin the transition zone in association with nodular hyperplasia and is often multicentric. The extent and zonal distribution of AAH and carcinoma show a weak but significant association.
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PMID:Atypical adenomatous hyperplasia of the prostate. Relationship with carcinoma in 217 whole-mount radical prostatectomies. 753 24

Biopsy materials obtained in the American Cancer Society National Prostate Cancer Detection Project were reviewed at the Central Pathology Laboratory at the Armed Forces Institute of Pathology. Of 265 cases submitted, 177 were diagnosed as prostatic carcinoma, 7 as prostatic intraepithelial neoplasia (PIN), 13 as atypical glands or atypical hyperplasia, and the remaining 68 were benign hyperplasias. Irrespective of the means of detectin or the grading system used (Gleason or WHO-Mostofi), a large majority of the cancers were detected as low-grade tumors. Of 27 cases of PIN reported, 20 were associated with cancer, leaving 7 cases with the sole diagnosis of PIN. These data may indicate the increased use of prostate-specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS) in the United States is shifting the spectrum of prostate cancer pathology toward early low-grade tumors.
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PMID:Pathology review in an early prostate cancer detection program: results from the American Cancer Society-National Prostate Cancer Detection Project. 754 31

The detection rate of organ-confined prostate cancer by digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) of the prostate, as well as the value of a directed, guided transrectal core biopsy for the prostate (TRUS-guided biopsy) combined with systematic biopsy, were evaluated. The subjects were 171 patients with urinary symptoms suggestive of prostatic disease excluding those with clinical stage C and D prostate cancer. Twenty-five patients (14.6%) had prostate cancer, 127 (74.2%) had benign prostate hypertrophy, four (2.3%) had prostatic intraepithelial neoplasia, eleven (6.4%) had inflammation, and four (2.3%) had normal prostate tissue. The incidence of detection of hypoechoic findings by TRUS in the patients in whom nodules were detected by DRE or who had elevated serum PSA was higher than that in patients with negative diagnostic findings. In 22 of the 25 patients with prostate cancer, the cancer was detected by recognition of a hypoechoic area on TRUS. In 10 of these 22 patients, prostate cancer was also detected by systematic biopsy in isoechoic areas. Prostate cancer was detected by systematic biopsy in three patients without hypoechoic findings. The positive predictive value for patients with abnormal findings on all three tests was 64.3%, which is significantly higher than that for patients with any other combination of findings (p < 0.05). Our results indicate that the combination of DRE, serum PSA and TRUS is useful for the detection of organ-confined prostate cancer, and that TRUS and TRUS-guided prostate biopsy combined with systematic biopsy should be performed in patients with abnormal findings for both DRE and PSA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of digital rectal examination, serum prostate-specific antigen, transrectal ultrasonography and systematic prostate biopsy for the detection of organ-confined prostate cancer. 755 83


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