Atypical Small Acinar Proliferation: Repeat Biopsy and Detection of High Grade Prostate Cancer.

Andrew Leone,Joseph F Renzulli,Katherine Rotker,Jianhong Li,Anthony Mega,Stephen F Schiff,Ali Amin,Gyan Pareek,Christi Butler,Dragan Golijanin

doi:10.1155/2015/810159

Andrew Leone, Joseph F Renzulli + Show 8 more

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https://doi.org/10.1155/2015/810159

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Abstract

Purpose. Atypical small acinar proliferation (ASAP) is diagnosed in 1-2% of prostate biopsies. 30–40% of patients with ASAP may be diagnosed with prostate cancer (PCa) on repeat biopsy. Our objective was to examine the association between ASAP and subsequent diagnosis of intermediate/high risk PCa. Materials and Methods. Ninety-six patients who underwent prostate biopsy from 2000 to 2013 and were diagnosed with ASAP were identified. Clinicopathologic features were analyzed. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology. Results. 56/96 (58%) patients had a repeat biopsy. 22/56 (39%) were subsequently diagnosed with PCa. There was no significant difference in patients' characteristics. Presence of HGPIN on initial biopsy was associated with a benign repeat biopsy (68% versus 23%). 17/22 (77%) had Gleason grade (GG) 3+3 disease and only 5/22 (23%) had GG 3+4 disease. Conclusions. 22/56 patients (39%) of patients who underwent a subsequent prostate biopsy following a diagnosis of ASAP were found to have PCa. 77% of these men were diagnosed with GG 3+3 PCa. Only 23% were found to have intermediate risk PCa and no high risk PCa was identified. Immediate repeat prostate biopsy in patients diagnosed with ASAP may be safely delayed. A multi-institutional cohort is being analyzed.

Highlights

There are over one million prostate biopsies performed annually in the United States [1]
With the recent trend toward adoption of active surveillance (AS) for low risk prostate cancer (PCa) defined by NCCN criteria, such patients are followed using serum PSA and digital rectal exam (DRE) every 4–6 months with a repeat biopsy in 1 year
Prostate biopsies were performed using transrectal ultrasound guided prostate biopsy for elevated PSA and/or abnormal DRE and 96 patients were diagnosed with Atypical small acinar proliferation (ASAP)

Summary

Introduction

There are over one million prostate biopsies performed annually in the United States [1]. Previous studies have suggested that 17–70% of patients with ASAP have adenocarcinoma present on subsequent prostate biopsies [5, 6]. Current guidelines recommend immediate repeat biopsy within 3–6 months after the initial diagnosis of ASAP [7, 8]. Up to 80% of the patients who are found to have adenocarcinoma on repeat biopsy have low risk GG 6 PCa [9]. With the recent trend toward adoption of active surveillance (AS) for low risk PCa defined by NCCN criteria, such patients are followed using serum PSA and digital rectal exam (DRE) every 4–6 months with a repeat biopsy in 1 year.

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