Diagnostic and prognostic significance of prostatic intraepithelial neoplasia in patients presenting with symptoms of prostatism

A total of 70 patients with symptoms of prostate enlargement were studied and all of them were subjected to digital rectal examination, serum prostate specific antigen, serum acid phosphatase and ultrasonography. Prostatic tissue from transurethral resection 30 cases (43%), enucleation specimens 30 cases (43%), and transrectal tru-cut biopsy 10 cases (14 %), were obtained to ascertain the histological nature of the disease. It was found that 50 cases (71.4 %) were of benign prostatic hyperplasia, 15 (21.4 %) were prostatic carcinoma and the remaining 5 (7.1%) cases were prostatic intraepithelial neoplasia (PIN). Suspected cases were reviewed by haematoxylin and eosin staining and argyrophillic nucleolar organizer region (AgNOR)-staining and counting. In patients with benign lesions the mean AgNOR counts were between 3.5-4.5, in those with PIN the counts were between 4-5.5 and in those with carcinoma prostate the counts were higher than 5. AgNOR counting appears to be a good adjuvant to the existing diagnostic aids and provides better therapeutic and prognostic options for the clinicians.