Atypical Glands Suspicious for Cancer (ATYP)

Abstract

The diagnostic term “atypical glands suspicious for cancer (ATYP),” or “atypical small acinar proliferation (ASAP),” describes a small focus of prostate glands that exhibits architectural and cytological atypia and is suspicious for, yet falls short of, the diagnostic threshold for prostate cancer. It is not a distinct biological entity; rather, it encompasses a range of lesions of varying clinical significance, including under-sampled cancer, high-grade prostatic intraepithelial neoplasia (HGPIN), benign lesions that mimic cancer, and benign prostate glands with reactive atypia. An ATYP diagnosis in prostate needle biopsy is considered a risk factor for finding prostate cancer in subsequent biopsies. Such risk ranges from 27% to 47%, with an average of 42%, in recent studies. National Comprehensive Cancer Network (NCCN) recommends patients with ATYP on initial biopsies for additional biomarker testing, such as free PSA %, prostate health index (PHI) or 4Kscore, and imaging studies, to assess the risk of high-grade cancer and consider repeated biopsy with relative increased sampling of the site of the atypical diagnosis.