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Atypical small acinar proliferation (ASAP): Is a repeat biopsy necessary ASAP? A multi-institutional review.
A Leone1,2, B Gershman3, K Rotker1,2
1Division of Urology, Rhode Island Hospital, Providence, RI, USA.
Prostate Cancer and Prostatic Diseases
|February 10, 2016
Summary
Atypical small acinar proliferation (ASAP) on prostate biopsy rarely indicates high-grade cancer. Repeat biopsy may be unnecessary for many patients diagnosed with ASAP, potentially avoiding unnecessary procedures.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Atypical small acinar proliferation (ASAP) is found in 5% of prostate biopsies.
- 30-40% of patients with ASAP may develop prostate cancer (PCa) within 5 years.
- Current guidelines recommend repeat biopsy within 3-6 months for ASAP diagnosis.
Purpose of the Study:
- To investigate the association between ASAP and subsequent high-grade PCa diagnosis.
- To evaluate the necessity of immediate repeat biopsy after an ASAP diagnosis.
Main Methods:
- Retrospective multi-institutional review of 264 patients diagnosed with ASAP.
- Analysis of clinicopathologic features and subsequent PCa detection rates.
- Comparison between patients with subsequent PCa and those with benign repeat pathology.
Main Results:
- 34% of patients were diagnosed with PCa on repeat biopsy; 8% had high-grade PCa (Gleason 7-10).
- Higher pre-biopsy PSA levels correlated with increased risk of PCa detection.
- Of those with subsequent PCa, 78% had Gleason 3+3 disease.
Conclusions:
- Only 8% of the total cohort diagnosed with ASAP had high-grade PCa on repeat biopsy.
- Higher PSA levels are associated with a greater risk of PCa.
- Immediate repeat biopsy may be safely omitted for many men with an initial ASAP diagnosis.
