Chung S Leung

Publications (2)8.03 Total impact

• Article: A model to predict prostate cancer after atypical findings in initial prostate needle biopsy.

  Jennifer L Merrimen, Glenn Jones, Sundus A B Hussein, Chung S Leung, Linda R Kapusta, John R Srigley
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  ABSTRACT: Atypical small acinar proliferation can occur alone or with high grade prostatic intraepithelial neoplasia in either a discontinuous or contiguous pattern in a prostate needle biopsy. We assessed whether different subgroups of atypical small acinar proliferation and high grade prostatic intraepithelial neoplasia denote a differing risk of detecting subsequent prostate cancer. We reviewed the pathological findings in 12,304 men who underwent initial prostatic needle biopsy during May 1999 to June 2007. Patients were included in the study if the initial diagnosis was atypical small acinar proliferation alone or combined with high grade prostatic intraepithelial neoplasia, or a benign diagnosis, and if followup prostatic needle biopsy was done. Prostate cancer developed in 22%, 27% and 49% of patients in the benign, high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation groups, respectively (p <0.0005). In all subgroups there was a 35% to 57% rate of prostate cancer detection. The prostate cancer risk increased in the atypical small acinar proliferation subgroups according to the extent of high grade prostatic intraepithelial neoplasia in the initial sample, with atypical small acinar proliferation associated with multifocal high grade prostatic intraepithelial neoplasia carrying a 71% prostate cancer risk. Atypical small acinar proliferation combined with high grade prostatic intraepithelial neoplasia, particularly when associated with multifocal high grade prostatic intraepithelial neoplasia, is associated with a significant risk of prostate cancer detection on followup biopsy.
  The Journal of urology 02/2011; 185(4):1240-5. · 4.02 Impact Factor
• Article: Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma.

  Jennifer L Merrimen, Glenn Jones, Danielle Walker, Chung S Leung, Linda R Kapusta, John R Srigley
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  ABSTRACT: There is debate in the literature on the role of high grade prostatic intraepithelial neoplasia as a risk factor for subsequent prostatic adenocarcinoma detection on prostatic needle biopsy. We determined whether high grade prostatic intraepithelial neoplasia on initial prostatic needle biopsy is an independent risk factor for prostatic adenocarcinoma and whether differences exist between prostatic adenocarcinoma in patients with previous high grade prostatic intraepithelial neoplasia and those with a benign diagnosis. Pathological findings in prostatic needle biopsies in 12,304 men who underwent initial prostatic needle biopsy in an 8-year period were analyzed. Patients were included in the analysis when the initial diagnosis was high grade prostatic intraepithelial neoplasia alone or a benign diagnosis and at least 1 followup prostatic needle biopsy was performed. The primary study outcome was prostatic adenocarcinoma and secondary outcome measurements were cancer characteristics, such as Gleason score and extent of tissue involvement with prostatic adenocarcinoma. In the high grade prostatic intraepithelial neoplasia group of 564 patients and the benign group of 845, 27.48% and 22.01%, respectively, were diagnosed with prostatic adenocarcinoma on followup prostatic needle biopsy (p = 0.02). When age, prostate specific antigen and sampling extent were adjusted for, the adenocarcinoma risk after an initial diagnosis of high grade prostatic intraepithelial neoplasia remained significant (OR 1.38, p = 0.03). The risk was related to the extent of high grade prostatic intraepithelial neoplasia in the initial sample with a greater likelihood of adenocarcinoma when multiple prostatic sites were involved by high grade prostatic intraepithelial neoplasia. Patients in whom prostatic adenocarcinoma developed after a benign diagnosis on initial prostatic needle biopsy had greater tumor volume. However, mean followup was longer in the benign group than in the high grade prostatic intraepithelial neoplasia group (2.35 vs 1.36 years). Patients with an initial diagnosis of high grade prostatic intraepithelial neoplasia, especially when multifocal, are at greater risk for subsequent prostatic adenocarcinoma than those with a benign diagnosis. Results suggest that followup should be more rigorous in patients with multifocal high grade prostatic intraepithelial neoplasia.
  The Journal of urology 07/2009; 182(2):485-90; discussion 490. · 4.02 Impact Factor