Diagnosis Of Atypical Small Acinar Proliferation Research Articles

The Rate of Clinically Significant Prostate Cancer on Repeat Biopsy after a Diagnosis of Atypical Small Acinar Proliferation: A Systematic Review and Meta-Analysis

<b><i>Introduction:</i></b> Atypical small acinar proliferation (ASAP) is detected in approximately 5% of prostate biopsies. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. However, clinical significance and outcomes of repeat biopsy are conflicting. Based on this situation, we conducted a meta-analysis to report the rate of clinically significant prostate cancer (csPCa) on repeat biopsy after a diagnosis of ASAP to determine the safety and validity of deferring repeat biopsy. <b><i>Methods:</i></b> We searched PubMed, Medline, Web of Science, and Embase databases for articles published until July 2023. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias for the included studies. Pooled ratios and 95% confidence intervals (CIs) were calculated using Stata 17. <b><i>Results:</i></b> Sixteen studies and 1,796 patients were included in the meta-analysis. A total of 553 patients were diagnosed with prostate cancer, and 204 had csPCa. The pooled rate of csPCa on repeat biopsy after ASAP diagnosis was 12.1% (95% CI: 0.09, 0.15), which is a relatively low progression rate. However, we observed heterogeneity among the 16 articles. Subgroup analysis was performed, and patients who underwent repeat biopsy within 6 months according to the guidelines had a lower csPCa incidence (effective size [ES] = 0.09, 95% CI: 0.060, 0.120) than those who underwent biopsy after more than 6 months (ES = 0.221, 95% CI: 0.094, 0.349). <b><i>Conclusion:</i></b> Repeat biopsy can be safely deferred for patients diagnosed with ASAP. We believe our results may help improve management strategies and encourage clinicians to choose more patient-friendly or non-invasive diagnostic evaluations.

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

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 ...

Rate of clinically significant prostate cancer on repeated biopsy after a diagnosis of atypical small acinar proliferation

Introduction: Current guidelines recommend repeat biopsy within 3-6 months for the diagnosis of atypical small acinar proliferation (ASAP) on prostate biopsy. Objectives: We aimed to evaluate the rate of progression of ASAP to clinically significant prostate cancer on repeat biopsy specimens and determine prognostic factors associated with progression. Patients and Methods: In a retrospective study we reviewed data of patients who had a prostate biopsy in our institution from March 2014 to March 2018. Gleason grade group (GGG) was conducted for pathology reporting. Logistic regression analysis was conducted for statistical analysis. Results: A total of 981 patients were identified of which 117 (12%) of them had a diagnosis of ASAP on their index biopsy. Out of these 16 (14%) patients underwent re-biopsy. Baseline clinicopathologic factors included a median age of 61 years, median pre-biopsy prostate-specific antigen (PSA) of 6.75 ng/mL and a mode of 1 core with ASAP. Median time interval between index and repeat biopsy was 10.5 months. The results of repeat biopsies were distributed across GGG system as follows; 12(75%) benign, 2 (12.5%) GG1, 1 (6.25%) GG2, and 1 (6.25%). We found no association between age, pre-biopsy PSA, and number of cores with ASAP, and progression of ASAP to clinically significant prostate cancer. Conclusion: Our study showed that patients with a diagnosis of ASAP are more likely to have a benign pathology on repeat biopsy. This finding supports previous studies regarding rethinking current guidelines for utility of repeat biopsy in patients with the diagnosis of ASAP.

Clinical strategy of repeat biopsy in patients with atypical small acinar proliferation (ASAP)

Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30–40% of patients with ASAP have biopsy detectable prostate cancer (PCa) within 5 years. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. The aim of the present study was to examine the association between ASAP and subsequent diagnosis of clinically significant PCa (csPCa). The need for immediate repeat biopsy was also evaluated. We identified 212 patients with an ASAP diagnosis on their first biopsy at our institution between February 2006 and March 2018. Of these patients, 102 (48.1%) had at least one follow-up biopsy. Clinicopathologic features including rates of subsequent PCa and csPCa were assessed. Thirty-five patients subsequently underwent radical prostatectomy (RP). Their pathologic results were reviewed. csPCa was defined as the presence of Gleason score (GS) ≥ 3 + 4 in ≥ 1 biopsy core. Adverse pathology (AP) was defined as high-grade (primary Gleason pattern ≥ 4) or non-organ-confined disease (pT3/N1) after RP. Of 102 patients, 87 (85.3%), 13 (12.7%), and 2 (2.0%) had one, two, and three follow-up biopsies, respectively. Median time from the initial ASAP diagnosis to the 2nd follow-up biopsy and the last follow-up biopsy were 21.9 months (range 1–129 months) and 27.7 months (range 1–129 months), respectively. Of these patients, 46 (45.1%) were subsequently diagnosed with PCa, including 20 (19.6%) with csPCa. Only 2 (2.0%) patients had GS ≥ 8 disease. Five (4.9%) patients had number of positive cores > 3. Of 35 patients who subsequently underwent RP, seven (20%) had AP after RP and 17 (48.6%) showed GS upgrading. Of these 17 patients, the vast majority (16/17, 94.1%) had GS upgrading from 3 + 3 to 3 + 4. 45.1% of patients with an initial diagnosis of ASAP who had repeat prostate biopsy were subsequently diagnosed with PCa and 19.6% were found to have csPCa. Our findings add further evidence that after a diagnosis of ASAP, a repeat biopsy is warranted and that the repeat biopsy should not be postponed.

Implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy: a 5-year follow-up study.

In the era of active surveillance of low- and intermediate-risk prostatic cancer, a reconsideration of the implications of a biopsy report of ASAP and/or HGPIN may be timely. We investigated the implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy. The rate of re-biopsy and the incidence of carcinoma on repeat biopsy for benign, HGPIN, and ASAP groups were compared. Mean PSA and PSA velocity was also compared between groups. There was an increased risk of developing prostate cancer in the following 5years with a biopsy diagnosis of ASAP compared to benign (20% vs 5.9%, p = 0.009), and with a biopsy of HGPIN compared with benign (14.8% vs 5.9%, p = 0.005). The frequency of repeat biopsy following a diagnosis of ASAP (54.2%) vs. HGPIN (37%) was not significantly different (p = 0.079). The risk of developing prostate cancer was highest following a biopsy with concomitant ASAP and HGPIN compared to benign (50% vs 5.9%, p < 0.001). There was no significant difference in PSA values between the 3 diagnostic groups at the time of initial biopsy (p = 0.206). The findings of this study suggest that a biopsy diagnosis of ASAP ± HGPIN, on either initial or surveillance biopsy, provides support for earlier repeat mpMRI and/or re-biopsy. This may assist in directing to early re-biopsy those patients likely to have intermediate- and high-risk prostate cancer.

Natural history of widespread high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: should we rebiopsy them all?

Objective To evaluate the premalignant potential of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Methods Patients diagnosed with monofocal HGPIN (mHGPIN), widespread HGPIN (≥4 cores, wHGPIN) and/or ASAP who underwent at least one rebiopsy during their follow-up, were enrolled. All enrollment biopsies underwent central pathologic revision. Risks for PCa were estimated using Fine and Gray method for competing risk. Results Pathologic revision changed the original diagnosis in 32.3% of cases. Among 336 cases enrolled, PCa was diagnosed in 164 (48.8%), and more specifically in 20 (30.3%) mHGPIN, 10 (34.5%) wHGPIN, 101 (54.0%) ASAP, and 33 (61.1%) HGPIN + ASAP (mean follow-up 124 months). Most PCa were Gleason score 6(3 + 3) (51.0%) and 7(3 + 4) (34.3%). On multivariate analysis, HGPIN + ASAP (HR 2.76, p < 0.001) and ASAP alone (HR 2.41, p < 0.001) were the only lesions significantly associated with PCa development. Of all cancers detected, 64.3% were at first rebiopsy. A rebiopsy performed within 3 months after ASAP diagnosis had a 45% chance of finding PCa. At Kaplan–Meier survival curves, median PCa-free survival was 48.1 months for HGPIN + ASAP and 64.9 months for ASAP (p 0.0005 at Log-rank test). At 1 year, 70% of HGPIN + ASAP, 73% of ASAP, 89% of wHGPIN, and 84% of mHGPIN were PCa-free. Conclusion The diagnosis of ASAP and HGPIN strongly relies on the expertise of dedicated uro-pathologists. Finding of ASAP is a strong risk factor for a subsequent PCa diagnosis, advising a rebiopsy, possibly within 3 months. m/wHGPIN should not be routinely rebiopsied.

Implementation of repeat biopsy and detection of cancer after a diagnosis of atypical small acinar proliferation of the prostate.

Current guidelines recommend a repeat biopsy within 3-6 months after an initial diagnosis of atypical small acinar proliferation (ASAP) due to the high incidence of cancer detection on repeat biopsy. The current study sought to investigate practice patterns after a diagnosis of ASAP in a real-world setting and examine the clinicopathological outcomes of repeat biopsy. The departmental database of the Hyogo Prefectural Nishinomiya Hospital identified 97 of 1,218 patients with a diagnosis of ASAP on initial biopsy from 2011 to 2016. Clinical and pathological data were retrospectively analyzed. Of the 97 patients, 34 (35.1%) underwent a repeat biopsy. Patients with a repeat biopsy had a significantly higher prostate-specific antigen (PSA) velocity and shorter PSA doubling time than patients without a repeat biopsy (P=0.0002), and of these 34 patients with a repeat biopsy, 16 (47.1%) were diagnosed as having cancer. Multivariate logistic regression analysis revealed that a small prostate (P=0.0250) and advanced age (P=0.0297) were associated with cancer detection on repeat biopsy. Of the 16 cancers identified, 13 (81.6%) were diagnosed with a Gleason score >6. The results indicated that the implementation of a repeat biopsy for patients with ASAP could be affected by clinical characteristics in real-world settings, despite the current recommendation of guidelines endorsing immediate repeat biopsy. Prostate volume and age would aid in the decision-making process to perform repeat biopsy in patients with high PSA velocity and short PSA doubling time after a diagnosis of ASAP.

Mean Platelet Volume as an Inflammation Marker, Possible Biomarker of Tumor Detection in Prostate Biopsy

Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume before prostate biopsy in predicting the results of pathology. Transrectal ultrasound-guided biopsy of the prostate was performed because of high PSA values and compared values of these parameters to predict of pathology results. Methods: 2715 patients who underwent 10 - 12 quadrant transrectal ultrasound-guided prostate biopsies between January 2008 and January 2018 have been evaluated retrospectively. Patients were divided into groups according to the biopsy pathology results by benign (group 1), atypical small acinar proliferation (ASAP) (group 2) and prostate cancer (group 3). A total of 204 patients who were benign prostate hyperplasia in 71 patients (34.8%), atypical small acinar proliferation in 80 (39.21%) and prostate adenocarcinoma (PCa) in 53 patients (25.98%) were included in the study by systematic sampling. Before the biopsy total PSA (tPSA), free PSA (fPSA), rate of percentage of free to total prostate specific antigen (f/tPSA) rate, PSA density (PSA-D), white blood cell (WBC) count, blood neutrophil count (NC), blood lymphocyte count (LC), neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) were measured and compared in all groups. Differences in continuous variables were assessed using the ANOVA. Logistic regression was used to analyze the linear relationship between predictive variables and pathology results. P Results: NLR and PLR values were lower in group 1 than group 2 and were found statistically significant between in group 1 and group 2 (p: 0.03 and p: 0.02, respectively). MPV value was found 1.7 times higher in patients who were diagnosed with ASAP pathology than those with benign pathologies. Although there was statistically significant increase in MPV values in logistic regression results, no statistically significant diagnostic value was found. In addition MPV value was found 0.5 times higher in patients who were diagnosed patients with ASAP than prostate cancer group. ROC analysis showed that the optimal threshold was 7.65 femtoliter (sensitivity: 51%; specificity: 30%) and was found to be a statistically significant diagnostic value to distinguish groups 2 and 3. The lowest value of MPV was found in group 3. Conclusions: In cases where the PSA value is insufficient in predicting the pathology result, the effect of NLR, PLR and MPV on differential diagnosis can be kept in mind. While NLR and PLR are more useful in the diagnosis of ASAP, MPV is more effective in the diagnosis of malignancy.

Relationship between prostate cancer and atypical small acinar proliferation

Aim: To investigate the prostatic adenocarcinoma (PA) detection rate in follow up biopsies with an initial diagnosis of atypical small acinar proliferation (ASAP). Materials and Methods: In this study, the cases of ASAP diagnosis in prostate needle biopsy materials between January 2010 and December 2016 were retrospectively analyzed and the correlation between the results and the follow-up diagnoses of ASAP-diagnosed cases was investigated. Results: 62 cases with ASAP were included in the study and 21 (34%) of them were detected as PA after the follow-up diagnoses. Also ASAP and PA were detected at different localizations in 38% of the cases. Conclusion: We are on the opinion that it is important to increase the number of samples taken from other localizations as well as ASAP diagnosed quadrants when taking follow-up biopsies.

Outcomes of Prostate Atypical Small Acinar Proliferation and High-Grade Prostate Intraepithelial Neoplasm Patients

Objective: Atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two pathological findings occasionally noted in prostate biopsies. Previous Western studies reported that they were associated with prostate cancer. However, none Taiwanese series report the subsequent cancer detection in ASAP and HGPIN patients. This study aimed to examine the results of repeated biopsies in the patients with ASAP and HGPIN. Materials and Methods: A total of 220 consecutive patients with ASAP and/or HGPIN at our institute between January 1990 and December 2010 were enrolled. Patient demographics and clinical information were extracted from the electronic database of our institute. Prostate biopsies were performed through transrectal ultrasound guidance. The patients who had concurrent prostate cancer (n = 51) and no repeated prostate biopsies (n = 103) were excluded from the study. Patients with biopsy pathologies reporting low-grade prostatic intraepithelial neoplasia (n = 2) were also excluded. The remaining 64 patients were available for the final analysis. Results: Nearly, 38, 24, and 2 patients were initially diagnosed as ASAP, HGPIN, and ASAP along with HGPIN, respectively. After 10 years of follow-up, 36.8% patients in ASAP group developed prostate cancer, while 16.7% in HGPIN group and 100% in ASAP + HGPIN group. Median time to developing prostate cancer were 20 months in ASAP group, 31 months in HGPIN group, and 48 months in ASAP + HGPIN group. There was no significant difference of prostate cancer development between ASAP and HGPIN group (P = 0.291). Only older age, classified by 65 years, was significantly associated with a higher detection rate of prostate cancer. Conclusion: Patients with the initial diagnosis of ASAP or PIN has a high risk of developing prostate cancer. Therefore, those patients should be well announced and followed regularly.

Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm.

Guidelines for atypical small acinar proliferation (ASAP) diagnosed on prostate biopsy recommend repeat biopsy within 3-6months after diagnosis. We sought to discern the rate of detecting clinically significant prostate cancer on repeat biopsy and predictors associated with progression. We performed a retrospective chart review of patients who underwent prostate biopsy at our institution from January 1, 2008, to December 31, 2015. Gleason grade group (GGG) system and D'Amico stratification were used to report pathology and risk stratification, respectively. Logistic and linear regression analyses were performed. A total of 593 patients underwent transrectal ultrasound-guided prostate biopsy, of which 27 (4.6%) had the diagnosis of ASAP. Of these, 11 (41%) had a repeat biopsy. Median time from diagnosis to repeat biopsy was 147days (IQR 83.5-247.0). Distribution across the GGG system on repeat biopsy was as follows: 7 (63.6%) benign, 3 (27.3%) GG1, and 1 (9.1%) GG2. ASAP was not associated with subsequent diagnosis of clinically significant prostate cancer (OR 0.46, 95% CI 0.064-3.247, P=0.432). There was no association between ASAP and high cancer risk (ASAP: β=-0.12; P=0.204). Patients diagnosed with ASAP managed according to guideline recommendations are more likely diagnosed with benign pathology and indolent prostate cancer on repeat biopsy. These findings support prior studies suggesting refinement of guidelines in regard to the appropriateness and timeliness of repeat biopsy among patients diagnosed with ASAP.

Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue

To assess the incidence of clinically significant and insignificant prostate cancer after an initial biopsy that revealed either atypical small acinar proliferation (ASAP), high-grade prostatic intraepithelial neoplasia (HGPIN), or benign tissue. We retrospectively identified patients diagnosed with ASAP, HGPIN, or benign tissue who had a repeat prostate biopsy within 1 year of diagnosis during 1987-2015. We compared the incidence of any prostate cancer and clinically significant prostate cancer (based on Gleason score, prostate-specific antigen (PSA), number of positive cores, and core volume) for each diagnostic group. A total of 17,016 biopsies were performed in 12,817 patients during 1987-2015. Among the 615 patients who had a repeat biopsy within 1 year of their first, 261 (42.4%), 208 (33.8%), and 146 (23.8%) had ASAP, HGPIN, or benign tissue on the initial biopsy, respectively. The second biopsy demonstrated significant differences in prostate cancer detection rates between these 3 groups (34.1%, 20.2%, and 15.8%, respectively; P <.001), with cancer detected significantly more often in the ASAP group relative to other groups (P <.001 vs benign and P = .001 vs HGPIN). The rates of clinically significant prostate cancer did not differ between groups (8.0%, 6.7%, and 4.1%, respectively, P = .31). On repeat biopsy, rates of clinically significant prostate cancer did not differ between patients initially diagnosed with ASAP, HGPIN, or benign tissue. Elevated rates of prostate cancer after a diagnosis of ASAP appear to be largely due to differences in the rate of clinically insignificant disease.

The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy.

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation (ASAP) are more likely to progress to prostate cancer (PCa). Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone (TS) levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score (GS) were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3–6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 (20.3%) and 114 (79.7%) patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS (P < 0.001). However, there was no statistically significant association between GS postbiopsy and TS (P = 0.324). Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal.

PD26-10 INCIDENCE OF CLINICALLY-SIGNIFICANT PROSTATE CANCER AFTER A DIAGNOSIS OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP), PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN), OR BENIGN TISSUE

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2016PD26-10 INCIDENCE OF CLINICALLY-SIGNIFICANT PROSTATE CANCER AFTER A DIAGNOSIS OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP), PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN), OR BENIGN TISSUE Scott Wiener, Peter Haddock, Ilene Staff, and Joseph Wagner Scott WienerScott Wiener More articles by this author , Peter HaddockPeter Haddock More articles by this author , Ilene StaffIlene Staff More articles by this author , and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.371AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repeat prostate biopsy after an initial biopsy that fails to demonstrate cancer may reveal ′clinically-significant′ or ′insignificant′ cancer (based upon Gleason score, volume of disease, and PSA). Here, we assess the incidence of clinically significant and insignificant prostate cancer after an initial biopsy revealed either ASAP, PIN, or benign tissue. METHODS We retrospectively identified patients who underwent repeat biopsy within 1 year at our clinical center during 1987-2015 and were diagnosed with either ASAP, PIN, or benign tissue after an initial biopsy. The incidence of clinically-significant cancer (Gleason ≥7, or Gleason 6 plus any of the following: PSA >10, or ≥3 cores positive, or >50% core volume) was compared between each cohort. RESULTS 17,016 sets of biopsies in 12,817 patients were performed during 1987-2015. In patients who underwent rebiopsy within 1 year, 261 (42.4%), 208 (33.8%) and 147 (23.8%) had ASAP, PIN or benign tissue, respectively, on initial biopsy. There were no statistical differences between the groups for the rate of detecting clinically significant cancer (8.0%, 6.7%, and 4.1%, respectively, p=0.31). The overall rate of cancer (clinically-significant or not) was statistically different among the three groups (26.1%, 13.5%, and 11.6%, respectively; p<0.001). Pair-wise comparisons indicate that the ASAP group differed from the other two (p<0.001 vs. benign and p=0.001 vs. PIN). CONCLUSIONS On repeat biopsy within 1 year, the incidence of clinically-significant prostate cancer is of a similarly low rate in patients who either harbor benign tissue, PIN, or ASAP on an initial biopsy. Elevated rates of prostate cancer detection after a diagnosis of ASAP thus appear to be largely due to differences in the rate of clinically-insignificant disease. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e648 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Scott Wiener More articles by this author Peter Haddock More articles by this author Ilene Staff More articles by this author Joseph Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Atypical small acinar proliferation (ASAP): Is a repeat biopsy necessary ASAP? A multi-institutional review.

Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30-40% of patients with ASAP may develop prostate cancer (PCa) within a 5-year period. Current guidelines recommend a repeat biopsy within 3-6 months after the initial diagnosis. Our objective was to examine the association between ASAP and subsequent diagnosis of high-grade PCa and to evaluate the need for immediate repeat biopsy. A retrospective multi-institutional review identified 264 patients who underwent prostate biopsy from 2000 to 2013 (Brown), 2008 to 2013 (University of Massachusetts) and 1994 to 2005 (Mayo) and were diagnosed with ASAP. Patients underwent transrectal ultrasound-guided biopsies for elevated PSA and/or abnormal digital rectal exam. Clinicopathologic features were assessed, including rates of subsequent PCa detection of any high-grade (Gleason 7-10) PCa. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology. All 264 patients included underwent repeat biopsy with a median follow-up of 5.4 years (interquartile range: 4.6, 6.7). Of these patients, 89 (34%) were subsequently diagnosed with PCa including 21 (8%) with high-grade PCa. Pre-biopsy PSA was higher among patients subsequently diagnosed with (6.7 vs 5.8, P<0.001). Of those diagnosed with subsequent PCa, 69/89 (78%) had less than or equal to Gleason 3+3 disease and only 15/89 (17%) had Gleason 7 and 6/89 (6%) revealed Gleason ⩾8-10. Radical prostatectomy was performed on 36/89 (40%) patients. Surgical pathology revealed 11 patients ⩾Gleason 8-10 PCa. Although 34% of patients with an initial diagnosis of ASAP who had repeat biopsy were subsequently diagnosed with PCa only, only 22% (8% of the total cohort) were found to have high-grade disease. Higher PSA was associated with increased risk of identifying PCa on repeat biopsy. These findings suggest that immediate repeat biopsy may be omitted in the majority of men with ASAP.

Abstract PR06: Effect of polyphenon E on progression to prostate cancer after diagnosis of high grade prostatic intraepithelial neoplasia

Abstract Importance: In recent years, several studies have suggested effectiveness of green tea catechins in prostate cancer (PCa) chemoprevention. With the exception of one trial from Italy, this has not been further tested in a randomized trial setting in high-risk men with atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN). Objective: To determine whether the daily consumption of a standardized formulation of green tea catechins (Polyphenon E) supplement for 1 year reduces the rate of progression to PCa in men, diagnosed with HGPIN or ASAP. Additional objectives were to evaluate tolerance, lower urinary tract symptoms (LUTS) and quality of life (QOL). Design, setting and participants: A randomized, double-blinded trial was conducted from September 2008 to March 2014 at medical centers in the US targeting 97 men diagnosed HGPIN or ASAP, randomized to treatment (n=49) or control arm (n=48). Supplement or placebo was initiated within 3 months of initial biopsy and continued for 1 year. Intervention: Participants were block randomized by baseline diagnosis and study site to receive Polyphenon E (PolyE), a decaffeinated, standardized green tea catechin mixture, the main component of which is (−)-epigallocatechin-3-gallate (EGCG) at a dose of 400 mgs EGCG per day (200 mgs twice a day [BID]), or placebo. Main outcomes and measures: Rate of progression to PCa at one year in men treated with PolyE or placebo following diagnosis of HGPIN or ASAP; evaluation of tolerance, LUTS and QOL. Results: Overall, we did not observe a difference in the number of men who progressed to PCa in one year in the Poly E (4/49) arm compared to placebo arm(6/48). Secondary analyses of patients reaching a definitive endpoint revealed that among men with baseline diagnosis of HGPIN, a greater number progressed to ASAP or PCa in the placebo arm (10/25) compared to the PolyE arm (3/26; P&amp;lt;0.05). Interestingly, this result was largely driven by the fact that a significantly greater number of subjects with baseline HGPIN progressed to ASAP in the placebo arm (5/25) compared to men in the PolyE arm (0/26; P &amp;lt;0.05). In men with baseline diagnosis of ASAP, the rate of cancer diagnosis at the end of intervention were similar in both study arms. Men in the PolyE group treated for one year demonstrated a significant decrease in serum tPSA compared to those in the placebo group (-0.90 ng/mL;(95%CI:-1.67, -0.12; P&amp;lt;0.05). No significant differences in tolerance, LUTS or QOL were observed between the two groups. Conclusions and Relevance: Daily intake of a standardized, decaffeinated catechin mixture containing 400 mgs EGCG (200 mgs BID) for 1 year is well tolerated and appears to produce chemoprevention effects in the early stages (HGPIN to ASAP) of prostate carcinogenesis. These findings should be confirmed in a phase III clinical trial prior to recommending use in clinical settings. Trial Registration: Clinical Trials.gov Identifier: NCT00596011 Acknowledgement: The research study was funded by the National Institute of Health- National Cancer Institute R01 CA12060-01A1. We acknowledge the contributions of Anthony M. Neuger, Domenico Coppola, Binglin Yue, (Moffitt Cancer Center); Kyle Anderson (Minneapolis VA Medical Center, Minneapolis, MN); Eduard Trabulsi (Jefferson Medical College, Philadelphia, PA); Tajammul Fazili (Overton Brooks VA, Shreveport, LA); Edward Giovanucci (Harvard University); Gregory Zagaja (University of Chicago, Chicago, IL); Shahnjayla Connors (University of Washington, St. Louis, MO); Folake Odedina (University of Florida). External Data Monitoring Board: Omer Kucuk, (Emory University), Phyllis Bowen (Retired), and Steven Clinton (Ohio State University). Citation Format: Nagi B. Kumar, Julio Pow-Sang, Kathleen M. Egan, Philippe A. Spiess, Shohreh Dickinson, Raoul Salup, Mohamed Helal, Jerry McLarty, Christopher R. Williams, Fred Schreiber, Said Sebti, Aslam Kazi, Loveleen Kang, Gwen Quinn, Tiffany Smith, Karen Diaz, Ganna Chornokur, Theresa Crocker, Michael J. Schell. Effect of polyphenon E on progression to prostate cancer after diagnosis of high grade prostatic intraepithelial neoplasia. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr PR06.

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

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.

Is immediate repeat biopsy necessary for men with atypical small acinar proliferation?

e16049 Background: Atypical small acinar proliferation (ASAP) is a diagnosis that occurs in about 1-2% of prostate biopsies. Approximately, 30-40% of patients with ASAP may develop prostate cancer....

1923 PROSTATE CANCER DETECTION AFTER DIAGNOSIS OF ATYPICAL SMALL ACINAR PROLIFERATION

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 20121923 PROSTATE CANCER DETECTION AFTER DIAGNOSIS OF ATYPICAL SMALL ACINAR PROLIFERATION Alexandre Rosen, Kyle Kiriluk, Scott Eggener, Gladell Paner, and Glen Gerber Alexandre RosenAlexandre Rosen Chicago, IL More articles by this author , Kyle KirilukKyle Kiriluk Chicago, IL More articles by this author , Scott EggenerScott Eggener Chicago, IL More articles by this author , Gladell PanerGladell Paner Chicago, IL More articles by this author , and Glen GerberGlen Gerber Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2080AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Atypical small acinar proliferation (ASAP) is diagnosed in 0.9 – 7.8% of prostate biopsies and is associated with an increased likelihood of prostate cancer on subsequent biopsies. Subsequent biopsy cancer detection rates vary from 27 – 59%. The focus of this study is to evaluate the significance of ASAP and subsequent cancer detection rates. METHODS A literature review focusing on the diagnosis of ASAP on prostate biopsy was performed using Medline to assess the published rates of prostate cancer on biopsy after ASAP diagnosis. The clinical and pathological records of 626 men who underwent 12-core prostate biopsy at the University of Chicago Medical Center between July 2008 and October 2010 were reviewed. The indication for biopsy included either an elevated PSA or suspicious DRE. Selection criteria included patients who had a biopsy revealing ASAP without evidence of cancer and subsequently underwent repeat biopsy at our same institution. Patients with a previous diagnosis of prostate cancer prior to the detection of ASAP were excluded. Pathology results including presence of ASAP or cancer, number of involved cores, and Gleason score were analyzed along with PSA values prompting initial biopsy. RESULTS During the 27-month period, 626 patients underwent prostate biopsy. Forty-eight patients (8%) had ASAP without concurrent cancer and were included in the analysis. Thirty-one patients (65%) with an initial biopsy revealing ASAP underwent repeat biopsy. Of these patients, six (20%) had a repeat diagnosis of ASAP on subsequent biopsy, fifteen (48%) had benign tissue, and ten (32%) were diagnosed with cancer. Of those diagnosed with cancer, eight patients were diagnosed with a score of Gleason 6 (80%) and two with Gleason 7 (20%). In patients diagnosed with ASAP, twenty-eight (58%) had one core positive, five (10%) had more than one core positive, and fifteen (31%) did not have a number of involved cores listed. Cancer was diagnosed in 22% of patients with a single ASAP core versus 60% of patients with more than one ASAP core. There was no statistically significant difference in PSA values of patients with ASAP undergoing biopsy and those who were subsequently diagnosed with cancer (7.47 ng/ml and 6.63 ng/ml, respectively; p=0.727). CONCLUSIONS ASAP found in multiple biopsy cores is associated with higher cancer detection rates on subsequent biopsy. Prior to repeat biopsy, the potential clinical significance of an underlying malignancy should be considered as these tend to be low-volume, low-risk cancers. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e776 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Rosen Chicago, IL More articles by this author Kyle Kiriluk Chicago, IL More articles by this author Scott Eggener Chicago, IL More articles by this author Gladell Paner Chicago, IL More articles by this author Glen Gerber Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Significance of Atypical Small Acinar Proliferation and High-Grade Prostatic Intraepithelial Neoplasia in Prostate Biopsy

PurposeIn clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases.Materials and MethodsOne hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded.ResultsOf the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy.ConclusionsThe diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.