Korean J Urol.  2010 Jun;51(6):398-402.

Pathologic Results of Radical Prostatectomies in Patients with Simultaneous Atypical Small Acinar Proliferation and Prostate Cancer

• Kim KH
• Kim YB
• Lee JK
• Kim YJ
• Jung TY

Abstract

PURPOSE
The incidence of adenocarcinoma on a subsequent biopsy following a diagnosis of atypical small acinar proliferation (ASAP) ranges from 34% to 60%. We reexamined radical prostatectomy (RP) specimens of patients diagnosed as having synchronous ASAP with prostate cancer (PCa) to evaluate pathological entities and the clinical significance of ASAP.
MATERIALS AND METHODS
From January 2007 to December 2008, a total of 118 patients who had been diagnosed with adenocarcinoma on prostate needle biopsy underwent RP. Forty-six of the 118 patients (39%) were diagnosed as having synchronous ASAP with PCa on the prostate needle biopsy. Using whole-mount sections and prostate mapping, we evaluated the RP specimens that were close sections to the ASAP on prostate needle biopsy. All tissues were examined by immunohistochemistry with high molecular weight cytokeratin (34betaE12), p63, and AMACR/P504S added to initial H&E stains by one pathologist.
RESULTS
Thirty-six of the 46 patients (78%) were diagnosed as having adenocarcinoma at sites of ASAP on the initial prostate needle biopsies. The Gleason score was 5 to 6 in 22 patients (61%), 7 in 3 (8%), and unknown due to multifocal and microfocal lesions in 11 (31%). The tumor volume of 14 of the 36 patients (39%) was 0.5 cc or less and was unknown due to multifocal and microfocal lesions in 8 (22%).
CONCLUSIONS
Most ASAP on initial prostate needle biopsy was a true pathological entity, in other words, prostatic adenocarcinoma. Aggressive approaches including more extended repeat biopsy with additional biopsy of the site of the ASAP are needed to diagnose PCa in patients with ASAP.

Keyword

Needle biopsy; Prostatectomy; Prostatic neoplasms; Surgical pathology

MeSH Terms

Adenocarcinoma
Biopsy
Biopsy, Needle
Coloring Agents
Humans
Immunohistochemistry
Incidence
Keratins
Molecular Weight
Neoplasm Grading
Passive Cutaneous Anaphylaxis
Pathology, Surgical
Prostate
Prostatectomy
Prostatic Neoplasms
Tumor Burden
Coloring Agents
Keratins

Figure

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  FIG. 1 Pathological stages and Gleason scores in 36 patients.

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