Atypical small acinar proliferation (ASAP): Is a repeat biopsy necessary ASAP? A multi-institutional review

Abstract

Although 34% of patients with an initial diagnosis of ASAP who had repeat biopsy were subsequently diagnosed with PCa only, only 22% (8% of the total cohort) were found to have high-grade disease. Higher PSA was associated with increased risk of identifying PCa on repeat biopsy. These findings suggest that immediate repeat biopsy may be omitted in the majority of men with ASAP.

Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm

“…For example, the recent ProtecT trial provides strong level I evidence regarding the safety and efficacy of active surveillance by demonstrating equivalent overall survival and cancer-specific survival when compared to management with either surgery or radiotherapy 11,17 . Reasonably, such patients may be best managed in accordance with current active surveillance guidelines to minimize the overutilization of prostate biopsies 9 . Moreover, one can consider further investigation with newer imaging modalities such as multi-parametric magnetic resonance imaging 18,19 or employ a less morbid transperineal template-guided approach on repeat biopsy 20 .…”

“…First, it reaffirms the rate of progression of clinically significant prostate cancer on repeat biopsy of approximately 10% 10,16,18,21 . In a multi-institutional review, Leone, et al 9 reported that on repeat biopsy 34% were diagnosed with prostate cancer; however, 8% had Gleason ≥7 disease. Consistent with these findings, Tosoian, et al 18 demonstrated 5% of patients with ASAP were diagnosed with Gleason ≥7 disease using magnetic resonance imaging/TRUS fusion-guided for repeat biopsy.…”

“…First, our study is limited by its retrospective design and small number of patients with ASAP diagnosis. Although sample size is small and not random, our sample mirrors prior index populations in other series 8,9 . Our study showed comparable rates of ASAP diagnosis on initial biopsy from larger retrospective studies and multi-institutional databases (4.5% vs 3.8–5.3%) 5,21,29,30 .…”

“…ASAP occurs at a rate of up to 5% on prostate biopsies, and it is known from prior studies that 30–50% of patients with an initial diagnosis of ASAP have progression to prostate cancer on repeat biopsy 6,7 . Previous studies have risk-stratified prostate cancer into clinically significant versus indolent disease on repeat biopsy following the diagnosis of ASAP 8,9 . However, existing data on its implication with regard to disease risk are conflicting.…”

Targeted histology sampling from atypical small acinar proliferation area detected by repeat transrectal prostate biopsy

“…В исследованиях отмечается, что атипическая мелко ацинарная пролиферация (АМАП) встречается у 5 % пациентов, которым выполнена биопсия ПЖ [4,5]. Изолированные комплексы АМАП -известный доказанный предиктор РПЖ.…”