Presence Of Atypical Small Acinar Proliferation Research Articles

MP57-11 RADICAL PROSTATECTOMY PATHOLOGICAL OUTCOMES IN MEN WITH PROSTATE CANCER DIAGNOSED ON REPEAT TRANSRECTAL ULTRASOUND PROSTATE BIOPSY AFTER INITIAL HIGH RISK BENIGN PATHOLOGY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2016MP57-11 RADICAL PROSTATECTOMY PATHOLOGICAL OUTCOMES IN MEN WITH PROSTATE CANCER DIAGNOSED ON REPEAT TRANSRECTAL ULTRASOUND PROSTATE BIOPSY AFTER INITIAL HIGH RISK BENIGN PATHOLOGY Ahmed Elshafei, Ganesh Kartha, Eric Klein, and J. Stephen Jones Ahmed ElshafeiAhmed Elshafei More articles by this author , Ganesh KarthaGanesh Kartha More articles by this author , Eric KleinEric Klein More articles by this author , and J. Stephen JonesJ. Stephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.665AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our aim is to assess disease burden in patients whose diagnosis was based on previous atypical small acinar proliferation (ASAP) and /or high grade intraepithelial neoplasia (HGPIN) on initial biopsy. METHODS We retrospectively reviewed pathology findings from 144 patients who underwent radical prostatectomy based on diagnosis of PCa following a negative initial biopsy. Patients were divided into two groups; 1.) 57 patients without ASAP or HGPIN on initial biopsy and 2.) 87 patients with high risk benign pathology (ASAP and /or HGPIN) on initial biopsy. We compared pathological outcomes after RP including Gleason upgrade, extraprostatic extension (EPE), surgical margin and seminal vesicle involvement between the two groups. RESULTS Preoperative characteristics showed that patients without prior ASAP or HGPIN on initial biopsy had significantly higher PSA (7.6ng/ml vs. 5.1ng/ml, p=0.0006), while there was no significant difference among other clinico-demographic criteria between patients with or without high risk benign pathology on initial biopsy. Table 1. Compared to those without prior ASAP or HGPIN findings on initial biopsy, RP patients with ASAP and/or HGPIN had a significantly lower EPE (27.8% vs.11.6%, p=0.015). Although it was not statically significant, patients with prior ASAP and/or HGPIN had a lower Gleason upgrade compared to patients without prior ASAP or HGPIN (23.8% vs. 31.5%). Table 2. CONCLUSIONS In men diagnosed with PCa by repeat transrectal biopsy, the presence of ASAP and/or HGPIN on initial biopsy is associated with a lower probability of adverse pathological outcomes at time of radical prostatectomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e756-e757 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmed Elshafei More articles by this author Ganesh Kartha More articles by this author Eric Klein More articles by this author J. Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predictors of prostate cancer in ultrasound-guided transperineal saturation biopsy in Turkish men with multiple prior negative biopsies.

Transperineal prostate biopsy (STPB) is associated with an improved cancer detection rate and an increase in anterior and apical prostate cancers compared to standard transrectal biopsy. A total of 48 men with at least two sets of prior prostate biopsies underwent transrectal ultrasound-guided STPB. Prostate rebiopsy indications were serum prostate-specific antigen (PSA) levels greater than 2.5 ng/mL and/or abnormal digital rectal examination and/or presence of high-grade prostatic intraepithelial neoplasia (HGPIN; ≥2 cores) or atypical small acinar proliferation (ASAP) at previous biopsies. The procedure was performed at dorsal lithotomy position under general anesthesia using a perineal 0.5 cm brachytherapy template attached to the transrectal ultrasound probe. Specimens from each zone were sent separately for pathological examination. Mean PSA level at STPB was 15.9 ng/mL (range 4.03 to 59.57). An average of 54.5 cores was obtained. Prostate adenocarcinoma was detected in 15 of 48 (31%) patients. Mean percentage of malignant cores was 11.9%. Multivariate logistic regression analysis revealed that age and presence of ASAP or HGPIN at previous biopsies were independent predictors of prostate cancer (p<0.05). No major complications, including sepsis and severe urinary or rectal bleeding, were observed in any of the patients. Five patients (10%) developed acute urinary retention after the procedure requiring urethral catheterization. Considerable number of patients with negative multiple biopsies were diagnosed with prostate cancer. STPB is a well-tolerated procedure with minimal morbidity, which can be considered for the diagnosis of prostate cancer in patients with previous negative biopsies.

The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates

To assess whether the addition of clinical Gleason score (Gs) 3+4 to the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria affects pathologic results in patients who are potentially suitable for active surveillance (AS) and to identify possible clinical predictors of unfavourable outcome. Three hundred and twenty-nine men who underwent radical prostatectomy with complete clinical and follow-up data and who would have fulfilled the inclusion criteria of the PRIAS protocol at the time of biopsy except for the addition of biopsy Gs=3+4 and with at least 10 cores taken have been evaluated. One experienced genitourinary pathologist selected those with real Gs=3+3 and 3+4 in only one core according to the 2005 International Society of Urological Pathology criteria. The primary end point was the proportion of unfavourable outcome (nonorgan confined disease or Gs⩾4+3). Logistic regressions explored the association between preoperative characteristics and the primary end point. Two hundred and four patients were evaluated and 46 (22.5%) patients harboured unfavourable disease at final pathology. After a median follow-up of 73.5 months, there was no cancer-specific death, and 4 (2.0%) patients had biochemical relapse. There were no significant differences in terms of high Gs, locally advanced disease, unfavourable disease and biochemical relapse-free survival among patients with clinical Gs=3+3 vs Gs=3+4. At multivariable analysis, the presence of atypical small acinar proliferation (ASAP) and lower number of core taken were independently associated with a higher risk of unfavourable disease. The inclusion of Gs=3+4 in patients suitable to AS does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of ASAP should be considered in patients suitable for AS.

Atypical small acinar proliferation of prostate: Follow-up study of 114 patients

Background and aim: Atypical small acinar proliferation (ASAP) is defined as atypical foci suspicious for but not diagnostic of malignancy. ASAP is known as a strong predictive factor associated with prostate cancer. Because the diagnostic criteria for ASAP are subjective, objective diagnostic criteria were applied for ASAP as follows: (i) total loss of basal cells confirmed by immunohistochemistry and inconspicuous nucleoli; and (ii) a minute (≤500 micrometer in length) focus of atypical glands with total loss of basal cells and prominent nucleoli. Methods: To evaluate the cancer detection rate of ASAP diagnosed by objective diagnostic criteria, 114 patients initially diagnosed with ASAP were reviewed. Results: ASAP was noted in 2.17% of prostate biopsy cases. Eighty-one patients were successfully followed up. Twenty patients (24.7%) were finally diagnosed as having adenocarcinoma by subsequent biopsy. According to the criteria, we subclassified ASAP into two groups: ASAP (not otherwise specified [NOS]) and ASAP (suspicious microscopic adenocarcinoma). ASAP (NOS) and ASAP (suspicious microscopic adenocarcinoma) showed significantly different cancer detection rates (20.3% vs 71.4%) at subsequent biopsies (P= 0.003). Sixteen patients underwent radical prostatectomy, and 13 cases (81.2%) were categorized as clinically significant prostate cancer. Conclusions: The presence of ASAP in needle biopsy was evaluated to be an important predictor of cancer.

The presence of prostate cancer on saturation biopsy can be accurately predicted

To improve the ability of our previously reported saturation biopsy nomogram quantifying the risk of prostate cancer, as the use of office-based saturation biopsy has increased. Saturation biopsies of 540 men with one or more previously negative 6-12 core biopsies were used to develop a multivariable logistic regression model-based nomogram, predicting the probability of prostate cancer. Candidate predictors were used in their original or stratified format, and consisted of age, total prostate-specific antigen (PSA) level, percentage free PSA (%fPSA), gland volume, findings on a digital rectal examination, cumulative number of previous biopsy sessions, presence of high-grade prostatic intraepithelial neoplasia on any previous biopsy, and presence of atypical small acinar proliferation (ASAP) on any previous biopsy. Two hundred bootstraps re-samples were used to adjust for overfit bias. Prostate cancer was diagnosed in 39.4% of saturation biopsies. Age, total PSA, %fPSA, gland volume, number of previous biopsies, and presence of ASAP at any previous biopsy were independent predictors for prostate cancer (all P < 0.05). The nomogram was 77.2% accurate and had a virtually perfect correlation between predicted and observed rates of prostate cancer. We improved the accuracy of the saturation biopsy nomogram from 72% to 77%; it relies on three previously included variables, i.e. age, %fPSA and prostate volume, and on three previously excluded variables, i.e. PSA, the number of previous biopsy sessions, and evidence of ASAP on previous biopsy. Our study represents the largest series of saturation biopsies to date.

RACE IS NOT A PREDICTOR OF PROSTATE CANCER DETECTION ON REPEAT PROSTATE BIOPSY

We evaluated men undergoing repeat prostate biopsies for persistently increased serum prostate specific antigen (PSA) levels to determine if race was a predictor of cancer detection. Between July 1995 and June 2002, 401 men had undergone 2 or more transrectal ultrasound guided prostate biopsies at our institutions. Clinical information was gathered using our prostate biopsy database and retrospectively reviewed. Race, age, serum PSA, PSA velocity, total number of biopsies performed, total number of previous negative cores and the presence of high grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on prior biopsy were evaluated to determine if they were predictors of subsequent cancer detection. Multivariate analysis was performed using a time dependent covariate Cox proportional hazards model. Of the 401 men undergoing repeat prostate biopsy, 91 (22.7%) were diagnosed with prostate cancer. In total there were 180 (44.9%) black men and 221 (55.1%) white men. Cancer was diagnosed in 49 black men (27.2%) and 42 white men (19.0%, p = 0.06). On multivariate analysis serum PSA, HGPIN, ASAP and PSA velocity were predictors of prostate cancer detection (p = 0.006, <0.0001, 0.001 and 0.0004, respectively). Race was not found to be a predictor of prostate cancer detection on repeat prostate biopsy (p = 0.16). In the evaluation of clinical data for racial differences, black men had a significantly higher incidence of HGPIN on prior biopsy compared to white men (p = 0.02). Serum PSA, PSA velocity, presence of ASAP on prior biopsy, age, number of biopsies performed and number of previous negative cores were not statistically different between black and white men. Race is not a predictor of prostate cancer detection in men undergoing repeat prostate biopsies. With the exception of HGPIN, all other clinical parameters were similar between black and white men. Serum PSA, PSA velocity, HGPIN and ASAP were found to be significant predictors of subsequent prostate cancer detection.