Volume 9, Number 3Point-CounterpointIs Repeat Biopsy for Isolated High-Grade Prostatic Intraepithelial Neoplasia Necessary?Point-CounterpointJacob RajferDhiren S DaveArnold I ChinNumerous studies have cited the positive predictive value of isolated highgrade prostatic intraepithelial neoplasia (HGPIN) to the detection of cancer. Epidemiological, morphological, and molecular data support the potential for malignant transformation of HGPIN, yet no current method can discriminate which lesions will progress to clinically significant prostate cancer versus more latent lesions. Recent analyses of multiple retrospective studies have found similar rates of cancer detection following either diagnosis of isolated HGPIN or an initial negative biopsy. This may reflect increased use of extended biopsy techniques involving 10 or more cores rather than the true ability of HGPIN to undergo malignant transformation. This article discusses controversies surrounding management of an isolated diagnosis of HGPIN and whether repeat biopsy of HGPIN should be mandatory or selective in the context of other predictive values such as rising prostate-specific antigen or lesion on digital rectal examination. [Rev Urol. 2007;9(3):124-131]Prostate cancerProstate biopsyRepeat biopsyProstatic intraepithelial neoplasia (PIN)High-grade PIN
Volume 9, Number 1Point-CounterpointIs the Testis a Chemo-Privileged Site? Is There a Blood–Testis Barrier?Point-CounterpointJacob RajferDhiren S DaveJohn T LeppertThe incidence of testicular cancer, primarily seminoma, has been increasing in many countries, including the United States. The testis is often the site of residual cancer after adequate treatment with systemic chemotherapy. The blood-testis barrier is commonly cited as the explanation for residual tumor within the gonad after chemotherapy and as the indication for delayed orchiectomy. Conversely, complete eradication of viable tumor from the primary site is common and argues against the testis as a “tumor sanctuary.” Residual tumor is also demonstrated within metastatic foci, and the disparity between the histopathologic response of the primary tumor and metastatic sites may be best explained by tumor heterogeneity and multiple tumor clones. Regardless of the scientific and academic arguments, delayed radical orchiectomy remains an important part of treatment for patients undergoing primary chemotherapy. [Rev Urol. 2007;9(1):28-32]ChemotherapyTesticular cancerBlood–testis barrierOrchiectomy