Atypical Glands Suspicious for Cancer

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 some architectural and cytological atypia and is suspicious for yet falls short of the diagnostic threshold for prostate cancer [1]. It is not a distinct biological entity; rather, it encompasses a broad 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 [2]. An ATYP diagnosis in prostate needle biopsy is a significant risk factor for detecting prostate cancer in a subsequent biopsy. Such risk ranges from 17% to 70%, with an average of 42%, in published studies [3, 4], compared with the 20–25% risk of cancer associated with an HGPIN diagnosis. Patients with ATYP on initial biopsies are therefore recommended to undergo immediate repeat biopsies [1].