Clinical strategy of repeat biopsy in patients with atypical small acinar proliferation (ASAP)

Abstract

Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30–40% of patients with ASAP have biopsy detectable prostate cancer (PCa) within 5 years. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. The aim of the present study was to examine the association between ASAP and subsequent diagnosis of clinically significant PCa (csPCa). The need for immediate repeat biopsy was also evaluated. We identified 212 patients with an ASAP diagnosis on their first biopsy at our institution between February 2006 and March 2018. Of these patients, 102 (48.1%) had at least one follow-up biopsy. Clinicopathologic features including rates of subsequent PCa and csPCa were assessed. Thirty-five patients subsequently underwent radical prostatectomy (RP). Their pathologic results were reviewed. csPCa was defined as the presence of Gleason score (GS) ≥ 3 + 4 in ≥ 1 biopsy core. Adverse pathology (AP) was defined as high-grade (primary Gleason pattern ≥ 4) or non-organ-confined disease (pT3/N1) after RP. Of 102 patients, 87 (85.3%), 13 (12.7%), and 2 (2.0%) had one, two, and three follow-up biopsies, respectively. Median time from the initial ASAP diagnosis to the 2nd follow-up biopsy and the last follow-up biopsy were 21.9 months (range 1–129 months) and 27.7 months (range 1–129 months), respectively. Of these patients, 46 (45.1%) were subsequently diagnosed with PCa, including 20 (19.6%) with csPCa. Only 2 (2.0%) patients had GS ≥ 8 disease. Five (4.9%) patients had number of positive cores > 3. Of 35 patients who subsequently underwent RP, seven (20%) had AP after RP and 17 (48.6%) showed GS upgrading. Of these 17 patients, the vast majority (16/17, 94.1%) had GS upgrading from 3 + 3 to 3 + 4. 45.1% of patients with an initial diagnosis of ASAP who had repeat prostate biopsy were subsequently diagnosed with PCa and 19.6% were found to have csPCa. Our findings add further evidence that after a diagnosis of ASAP, a repeat biopsy is warranted and that the repeat biopsy should not be postponed.

Systemic Immune-Inflammation Index Can Predict Clinically Significant Prostate Cancer in Patients with Atypical Small Acinar Proliferation: Descriptive Study

“…22 Kim et al reported a cs-PCa ratio of 19.6% and pointed out a 48.6% increase in the Gleason score post-RP. 23 These results support the observation that the cs-PCa rates after the second biopsy are higher compared to those found during the procedure, due to the nature of the prostate biopsy. In this study, the cs-PCa was 11.53% (15/130) in patients with ASAP diagnosis, while the Gleason score upgrade was 29.7% (11/37), which is considered consistent with the relevant literature.…”

The Rate of Clinically Significant Prostate Cancer on Repeat Biopsy after a Diagnosis of Atypical Small Acinar Proliferation: A Systematic Review and Meta-Analysis

“…3): ① median time to repeat biopsy, ② median age, and ③ median prostatespecific antigen (PSA). The result was consistent, and we discovered that ① patients who underwent a repeat biopsy within 6 months according to the guideline [35] had a lower incidence of csPCa (effective size (ES) = 0.09, 95% CI: 0.060, 0.120) than those who underwent a repeat biopsy after more than 6 months (ES = 0.221, 95% CI: 0.094, 0.349); ② the subgroup of patients with a median age below 65 years had a lower incidence of csPCa (ES = 0.097, 95% CI: 0.067, 0.127) than the subgroup of patients above 65 years (ES = 0.161, 95% CI: 0.086, 0.235); ③ the subgroup of patients with "8<PSA ≤10" had a higher risk of csPCa (ES = 0.209, 95% CI: 0.031, 0.387) than those with "4<PSA ≤6" (ES = 0.115, 95% CI: 0.050, 0.180) and "6<PSA ≤8" (ES = 0.078, 95% CI: 0.048, 0.108). The results of the subgroup analyses are summarized in Table 3.…”

Predictors for the progression to prostate cancer in patients diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation: a case–control study

“…Currently, the NCCN guidelines recommended repeating prostate biopsy within 3 to 6 months [11]. HGPIN was associated with at least 30% subsequent diagnosis of cancer within 1 year and ASAP indicated 30-40% morbidity to be prostate cancer on repeated biopsy [12,13]. Even some literatures reported a higher incidence of prostate cancer with concurrent HGPIN and ASAP [5].…”