PD26-11 BIOPSY PATTERNS OF PATIENTS WITH HGPIN OR ASAP IN THE ERA OF ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2016PD26-11 BIOPSY PATTERNS OF PATIENTS WITH HGPIN OR ASAP IN THE ERA OF ACTIVE SURVEILLANCE Zachary Panfili, MD Zachary Hamilton, MD Tim Walmann, BS Eugene Lee, MD David Duchene, MD, FACS Hadley Wyre, MD Brantley Thrasher, MD, FACS Jeffrey Holzbeierlein, andMD, FACS Moben MirzaMD, FACS Zachary PanfiliZachary Panfili More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Tim WalmannTim Walmann More articles by this author , Eugene LeeEugene Lee More articles by this author , David DucheneDavid Duchene More articles by this author , Hadley WyreHadley Wyre More articles by this author , Brantley ThrasherBrantley Thrasher More articles by this author , Jeffrey HolzbeierleinJeffrey Holzbeierlein More articles by this author , and Moben MirzaMoben Mirza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.372AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate the practice patterns of prostate biopsy in patients with high grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). METHODS After collecting practice and demographic data, we surveyed urologists of the South Central Section on their re-biospy practices of patients with HGPIN or ASAP. Clinical scenarios included patients age 55 or 69 years old with a PSA of 7 found to have 3 cores positive for HGPIN or ASAP on 12 core trans-rectal biopsy. Differences in selecting repeat PSA vs re-biopsy based on academic vs private practice, years of experience, and beliefs regarding the malignant potential of these lesions were examined. RESULTS 130 urologists completed the survey. Young patients with HGPIN were re-biopsied at 3-6 months and 6-12 months, 32.0% and 49.2% respectively. The same young patient with ASAP was re-biopsied at 3-6 months 70.9% of the time, (p=0.04). 62.2% of older patients with HGPIN had repeat PSA in 6-12 months and 17.7% were re-biopsied at 3-6 months. The same old patient with ASAP was re-biopsied 52.9% of the time, (p=0.01). There was no difference in management of HGPIN based on academic or private practice and years of experience regarding repeat PSA or re-biopsy. However, both young and old patients with ASAP were more likely to be re-biopsied in the academic setting (Young: 91.2% vs 62.7%, p=0.01) and (Old: 70.6% vs 45.9%, p=0.02); and by less experienced urologists (Young: 82.0% vs 62.7%, p= 0.02) and (Old: 66.0% vs 43.5%, p=0.02). HGPIN and ASAP are considered associated with prostate cancer 50.8% and 54.6%, (p=0.075) and premalignant by 33.1% and 41.5%, (p=0.481) of respondents respectively. Providers believing HGPIN is associated with prostate cancer re-biopsied young patients 68.3% and older patients 27.0% of the time (p=0.01). Those believing HGPIN is premalignant re-biopsied young patient 34.9% and older patients 17.7% of the time (p=0.623). Providers not believing HGPIN is associated with prostate cancer re-biopsied young patients 4.9% and older patient 0.0% of the time (p=0.01). CONCLUSIONS In an era of active surveillance where low risk prostate cancer is re-biopsied at one year, our practice of performing re-biopsy of HGPIN and ASAP 3-6 months after diagnosis is incongruent with our current understanding of prostate cancer. HGPIN and ASAP are biologically different entities and our education and practice patterns need to be updated. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e648 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Zachary Panfili More articles by this author Zachary Hamilton More articles by this author Tim Walmann More articles by this author Eugene Lee More articles by this author David Duchene More articles by this author Hadley Wyre More articles by this author Brantley Thrasher More articles by this author Jeffrey Holzbeierlein More articles by this author Moben Mirza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...