I also had an HGPIN detected from a biopsy. I was told just to continue regular PSA testing and that an increase in the PSA would warrant further investigation.

As it turned out, I had to change urologists and at my initial appointment with the second urologist he did a PSA test and DRE. The PSA was stable with previous readings and the DRE was normal. I requested one of the 'then-new' urine tests which look for prostate cancer markers in the urine - I was given the ExoDx test though there are others now that may be better. The ExoDx indicated a 36% probability of clinically significant prostate cancer and that led to a saturation biopsy which showed a low percentage (less than 5%) of Gleason 9 cancer in 2 of the 24 cores. I had a RALP six weeks later and the post-surgery pathology report downgraded my Gleason score to Gleason 7 (4+3) with tertiary pattern 5.

There is no way of knowing whether my HGPIN progressed to the cancer found 18 months later in the second biopsy, but in discussing my case with the urologist he indicated that if an HGPIN is found in a biopsy, he recommends doing a second biopsy one year later. I also think a saturation biopsy, where something like 24 cores are taken sampling all areas of the prostate, is a good idea especially in light of my case where only 2 of the 24 cores showed cancer and a very low percentage in those. Finally, for what it is worth, the urologist who did the saturation biopsy did a transrectal biopsy - not the transperineal version. He said that he feels that he is able to better access all areas of the prostate with the transrectal version.

So in summary, I would suggest a follow up biopsy in a year and ask for a saturation biopsy to make sure the prostate is thoroughly sampled.