MP55-09 NATURAL HISTORY OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP): A 10-YEAR CONTEMPORARY SERIES

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You have accessJournal of UrologyCME1 Apr 2023MP55-09 NATURAL HISTORY OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP): A 10-YEAR CONTEMPORARY SERIES Thineskrishna Anbarasan, Mutie Raslan, Kanchan Ghosh, Philip Macklin, Claudia Mercader, Tom Leslie, Freddie Hamdy, Richard Colling, Clare Verrill, Richard Bryant, Francisco Lopez, and Alastair Lamb Thineskrishna AnbarasanThineskrishna Anbarasan More articles by this author , Mutie RaslanMutie Raslan More articles by this author , Kanchan GhoshKanchan Ghosh More articles by this author , Philip MacklinPhilip Macklin More articles by this author , Claudia MercaderClaudia Mercader More articles by this author , Tom LeslieTom Leslie More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , Richard CollingRichard Colling More articles by this author , Clare VerrillClare Verrill More articles by this author , Richard BryantRichard Bryant More articles by this author , Francisco LopezFrancisco Lopez More articles by this author , and Alastair LambAlastair Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Atypical small acinar proliferation (ASAP), found in 5% of prostate biopsies, represents a focus of atypical cells. There is a paucity of high-quality evidence on follow-up of ASAP with repeat biopsies. We aim to assess the incidence of ASAP and detection of PCa, particularly the proportion which are clinically significant (csPCa). METHODS: We conducted a retrospective review of electronic patient records (OSF protocol registration ID: CU96T) for all consecutive patients between Jan 2010 and Nov 2021 at a single tertiary institution. csPCa was defined as any Gleason pattern 4 disease. Between group median PSA levels were compared using the Kruskal-Wallis test. RESULTS: Approximately 13000 prostate samplings were performed (11000 needle biopsy and 2000 HOLEP/TURP specimen). ASAP was identified in 617/13000 (4.7%) biopsy samplings involving 523 patients. Of these, 10 (1.9%) and 41 (7.8%) patients had concurrent or a history of PCa respectively and were excluded from further analysis (N=472). At detection of ASAP, the median age was 66 years (IQR:61-71) with a median pre-biopsy PSA of 7.25ng/mL (IQR: 5.35-10.75). A total of 237 (50.2%) patients had a repeat biopsy within a median of 92 days (IQR:56-283). Median PSA after 3-6 months of ASAP detection was higher among patients who subsequently underwent repeat biopsy (6.70 vs 5.08ng/mL, p=0.001). Of 237 patients who underwent repeat biopsies within 2 years, csPCa was found in 57 (24.1%) patients (18 high grade vs 39 intermediate grade) at a median interval of 128 days (IQR:61-260). Clinically insignificant PCa was more common on follow-up, detected in 77 (32.5%) patients. The incidence of csPCa was lower in those younger than 65 years (0.20 vs 0.32, p=0.026) (Figure 1). csPCa was detected on the ipsilateral side of ASAP diagnosis in 46/57 (80.8%) patients. When including patients who did not undergo repeat biopsies and had stable PSA on follow-up (<10 ng/mL over 2 years; n=78), overall incidence of csPCa was 18.1% (57/315). CONCLUSIONS: PCa detected in follow-up biopsies in patients with ASAP was clinically significant in approximately one quarter of cases. Ipsilateral side with ASAP should be adequately sampled owing to association with detection of csPCa. Current guidelines should be revised to consider resampling following detection of ASAP. Source of Funding: NIL © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e766 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thineskrishna Anbarasan More articles by this author Mutie Raslan More articles by this author Kanchan Ghosh More articles by this author Philip Macklin More articles by this author Claudia Mercader More articles by this author Tom Leslie More articles by this author Freddie Hamdy More articles by this author Richard Colling More articles by this author Clare Verrill More articles by this author Richard Bryant More articles by this author Francisco Lopez More articles by this author Alastair Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...