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Prostate atypia: does repeat biopsy detect clinically significant prostate cancer?
Ryan P Dorin1, Scott Wiener, Cory D Harris
1Urology Division, Hartford Hospital, Hartford, Connecticut, USA.
The Prostate
|January 20, 2015
Summary
Atypical small acinar proliferation (ASAP) on initial prostate biopsy indicates a significant risk of prostate cancer (PCa) on repeat biopsy. Patients with ASAP require careful counseling regarding potential PCa diagnosis.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Established treatment pathways exist for benign and malignant prostate biopsies.
- Uncertainty remains regarding the risk of subsequent prostate cancer (PCa) diagnosis after an initial diagnosis of prostate atypia.
Purpose of the Study:
- To investigate the likelihood of a repeat prostate biopsy diagnosing PCa in patients initially diagnosed with prostate atypia.
Main Methods:
- A prospectively maintained prostate biopsy database was reviewed for patients diagnosed with atypia (atypical small acinar proliferation; ASAP) between November 1987 and March 2011.
- Patients with a history of PCa were excluded; repeat biopsies within one year were analyzed.
- Subsequent treatments (radical prostatectomy, radiotherapy, active surveillance) were recorded.
Main Results:
- Of 567 patients with initial ASAP, 287 underwent repeat biopsy within one year.
- Prostate cancer (PCa) was diagnosed in 102 (35.6%) of these repeat biopsies.
- Over half (51%) of the PCa cases identified on repeat biopsy were clinically significant.
Conclusions:
- Initial ASAP diagnosis is linked to a substantial risk of PCa upon repeat biopsy, particularly in patients undergoing definitive local therapy.
- Patients with ASAP should be informed about the probability of harboring clinically significant or insignificant prostate cancer.
