Newly Diagnosed with Prostatic Intraepithelial Neoplasia (PIN)?

If you can manage to pronounce it, ask your doctor about prostatic intraepithelial neoplasia (PIN), particularly if you are at a high risk for prostate cancer. If you have undergone a prostate exam, followed by a prostate biopsy, then “prostatic intraepithelial neoplasia” or “PIN” is one of the possible diagnoses your doctor may give you. In some cases, this condition may be a precursor to prostate cancer.

What is PIN?

If your doctor tells you that you have prostatic intraepithelial neoplasia, this means that some of the cells in your prostate gland appear and behave abnormally. These abnormal cells might be located in the lining of the acini, which are tiny sacs in the prostate gland, or the cells might be located in the lining of the ducts that carry semen.

The affected cells are called epithelial cells. Although the cells change, the lining itself is not affected. In a man with prostate cancer, the lining ruptures and the cancerous cells have access to the prostate gland tissues.

Is PIN cancerous?

There is no definitive answer to this. PIN is often referred to as a precancerous condition, however being diagnosed with PIN is no guarantee that you will develop prostate cancer. Previously, prostatic intraepithelial neoplasia was classified into three different grades, appropriately named grades 1, 2, and 3. Low-grade PIN was considered to be grade 1, and men diagnosed with it do not have an increased risk of prostate cancer. Grades 2 and 3 are considered to be higher grades, with a possible increased risk of prostate cancer.

These days, PIN is simply referred to as “low-grade” or “high-grade.” But even having high-grade PIN does not automatically mean you will develop cancer. Similarly, you can be diagnosed with prostate cancer without ever having been diagnosed with PIN.

How is PIN diagnosed?

Diagnosing prostatic intraepithelial neoplasia tends to happen by accident. A prostate exam cannot detect the abnormal cells. Even a PSA screening is useless for this purpose because PIN does not elevate PSA levels. Your doctor may discover PIN during a prostate biopsy. If you undergo transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia (BPH), or an enlarged prostate, your doctor may also discover PIN.

What happens next?

If you’re diagnosed with prostatic intraepithelial neoplasia, avoid hitting the panic button. It does not automatically mean you will develop prostate cancer, although it is always a good idea to become an informed patient about prostate health and other men’s health issues.

There is no standard of treatment or even a standard protocol for follow-up evaluations for PIN. Doctors remain divided, so it’s a good idea to get a second or third opinion. Some doctors might recommend that you undergo additional screenings if you have high-grade PIN. Tests might include blood screenings for PSA levels and a transrectal ultrasound. A doctor might recommend that you undergo another prostate biopsy in several months to a year, or even in three years.