Korean J Urol.  2009 Mar;50(3):237-240.

Prostate Cancer Detection Rate of Rebiopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate

• Oh JW
• Kim YB
• Yang SO
• Lee JK
• Kim YJ
• Jung TY
• Shim HB

Abstract

PURPOSE: Atypical small acinar proliferation (ASAP) denotes the presence of suspicious glands with insufficient cytological architecture for a definitive prostate cancer diagnosis. We evaluated the subsequent prostate cancer detection rate of rebiopsy in patients with an initial diagnosis of ASAP.
MATERIALS AND METHODS
Between January 2003 and December 2006, 1,416 men with suspected prostate cancer underwent a transrectal ultrasound-guided prostate biopsy, and 214 (15.1%) were diagnosed as having ASAP. Ninety-five of the 215 patients underwent at least one more biopsy. We evaluated the cancer detection rates after rebiopsy.
RESULTS
In men with ASAP, 36 patients (37.9%) had prostate cancer. The cancer detection rates of the 1st, 2nd, and 3rd rebiopsies were 30.5%, 23.8%, and 40%, respectively. Mean patient age and prostate-specific antigen did not differ significantly between the prostate cancer and noncancer groups after rebiopsy. Prostate volume, however, was significantly smaller in the cancer group (p<0.05).
CONCLUSIONS
Our results showed a detection rate for prostate cancer of 37.9% after an initial diagnosis of ASAP, which indicates that an initial diagnosis of ASAP mandates rebiopsy.

Keyword

Atypical small acinar proliferation; Biopsy; Prostatic neoplasms

MeSH Terms

Biopsy
Humans
Male
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Prostate-Specific Antigen

Reference

1.Kang MY., Park JH., Kwak C., Paick JS., Kim HH. Transrectal needle biopsy of the prostate: the efficacy of a pre-biopsy enema. Korean J Urol. 2008. 49:248–51.

2.Hyun CL., Lee HE., Kim HR., Lee HS., Park SY., Chung JH, et al. Pathological analysis of 1,000 cases of transrectal ultrasound guided systematic prostate biopsy: establishment of new sample processing method and diagnostic utility of immunohistochemistry. Korean J Pathol. 2006. 40:406–19.

3.Iczkowski KA., Chen HM., Yang XJ., Beach RA. Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy. Urology. 2002. 60:851–4.

4.Fadare O., Wang S., Mariappan MR. Practice patterns of clinicians following isolated diagnoses of atypical small acinar proliferation on prostate biopsy specimens. Arch Pathol Lab Med. 2004. 128:557–60.

5.Schlesinger C., Bostwick DG., Iczkowski KA. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: predictive value for cancer in current practice. Am J Surg Pathol. 2005. 29:1201–7.

6.Borboroglu PG., Sur RL., Roberts JL., Amling CL. Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J Urol. 2001. 166:866–70.

7.Cheville JC., Reznicek MJ., Bostwick DG. The focus of "aty-pical glands, suspicious for malignancy" in prostatic needle biopsy specimens: incidence, histologic features, and clinical follow-up of cases diagnosed in a community practice. Am J Clin Pathol. 1997. 108:633–40.

8.Iczkowski KA., Bassler TJ., Schwob VS., Bassler IC., Kunnel BS., Orozco RE, et al. Diagnosis of "suspicious for malig-nancy" in prostate biopsies: predictive value for cancer. Urology. 1998. 51:749–58.

9.Iczkowski KA., MacLennan GT., Bostwick DG. Atypical small acinar proliferation suspicious for malignancy in prostate needle biopsies: clinical significance in 33 cases. Am J Surg Pathol. 1997. 21:1489–95.

10.Chan TY., Epstein JI. Follow-up of atypical prostate needle biopsies suspicious for cancer. Urology. 1999. 53:351–5.

11.Renshaw AA., Santis WF., Richie JP. Clinicopathological characteristics of prostatic adenocarcinoma in men with atypical prostate needle biopsies. J Urol. 1998. 159:2018–22.

12.Park S., Shinohara K., Grossfeld GD., Carroll PR. Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy. J Urol. 2001. 165:1409–14.

13.Epstein JI. How should atypical prostate needle biopsies be reported? Controversies regarding the term ‘ASAP'. Hum Pathol. 1999. 30:1401–2.

14.Thorson P., Vollmer RT., Arcangeli C., Keetch DW., Humphrey PA. Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up. Mod Pathol. 1998. 11:543–51.

15.Epstein JI., Herawi M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol. 2006. 175:820–34.

16.Allen EA., Kahane H., Epstein JI. Repeat biopsy strategies for men with atypical diagnoses on initial prostate needle biopsy. Urology. 1998. 52:803–7.

17.Halushka MK., Kahane H., Epstein JI. Negative 34betaE12 staining in a small focus of atypical glands on prostate needle biopsy: a follow-up study of 332 cases. Hum Pathol. 2004. 35:43–6.

18.Murphy WM. ASAP is a bad idea. Atypical small acinar proliferation. Hum Pathol. 1999. 30:601.

19.Brausi M., Castagnetti G., Dotti A., De Luca G., Olmi R., Cesinaro AM. Immediate radical prostatectomy in patients with atypical small acinar proliferation. Over treatment? J Urol. 2004. 172:906–8.

20.Mancuso PA., Chabert C., Chin P., Kovac P., Skyring T., Watt WH, et al. Prostate cancer detection in men with an initial diagnosis of atypical small acinar proliferation. BJU Int. 2007. 99:49–52.

21.Epstein JI., Potter SR. The pathological interpretation and significance of prostate needle biopsy finding: implication and current controversies. J Urol. 2001. 166:402–10.

22.Scattoni V., Roscigno M., Freschi M., Briganti A., Fantini GV., Bertini R, et al. Predictors of prostate cancer after initial diagnosis of atypical small acinar proliferation at 10 to 12 core biopsies. Urology. 2005. 66:1043–7.