How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

Abstract

ARTICLE INfO ______________________________________________________________ ______________________Objective: To compare cancer detection rates according to the number of biopsy cores in patients on whom a repeat prostate biopsy was performed for atypical small acinar proliferation (ASAP). Materials and Methods:The data of 4950 consecutive patients on whom prostate biopsies were performed were assessed retrospectively. A total of 107 patients were identified as having ASAP following an initial prostate biopsy, and they were included in the study. A six-core prostate biopsy (PBx) was performed on 15 of the 107 patients, 12 PBx on 32 patients, and 20 PBx on 60 patients. Cancer detection rates were compared according to the number of biopsy cores. The localization of the cancer foci was also evaluated.Results: The cancer detection rates in patients on whom 6 PBx, 12 PBx, and 20 PBx were performed were 20% (3/15), 31% (10/32), and 58% (35/60), respectively, and a statistically significant difference was found (p = 0.005). When cancer detection rates in patients with total prostate specific antigen (PSA) < 10ng/mL, PSA density ≥ 0.15, normal digital rectal examination, and prostate volume ≥ 55mL were compared according to the number of biopsy cores, a significant difference was identified (p = 0.02, 0.03, 0.006, and 0.04, respectively). Seventy-five percent of the foci where cancer was detected were at the same and/or adjacent sites as the ASAP foci in the initial biopsy, and 54% were identified in contralateral biopsies in which ASAP foci were present. Conclusion: As the biopsy core number increases, the cancer detection rate increases significantly in patients on whom a repeat biopsy is performed due to ASAP. The highest cancer rate is found in 20-core repeat biopsies performed equally from all foci.

Implementation of repeat biopsy and detection of cancer after a diagnosis of atypical small acinar proliferation of the prostate

“…The probability of Gleason score greater than 6, which is considered high-grade cancer, on repeat biopsy after a diagnosis of ASAP substantially varies from 8.0 to 66.7% among different studies (12,(14)(15)(16)(17)19,21,22). In the present cohort, 13 (81.3%) of the 16 cancers were diagnosed as Gleason score greater than 6 on repeat biopsy after a diagnosis of ASAP, which is higher than the rates in the preceding reports.…”

“…This could be one reason, therefore, that small prostate volume was found to be a predictor for cancer detection in the present analysis. Actually, the rate of cancer detection was reported to rise as the number of biopsy cores was increased on repeat biopsy for large prostates in patients with a previous diagnosis of ASAP (21). The increasing number of cores would contribute to the detection of cancer on repeat biopsy after a diagnosis of ASAP, especially for patients with large prostates.…”

“…However, the evidence on ASAP is still limited, and no prospective study on ASAP has been reported so far. Remarkably, the probability of cancer found on repeat biopsy ranges from 20.0 to 71.6% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Clinical and pathological predictors reported for cancer detection on repeat biopsy after an ASAP diagnosis vary among studies (7,12,16,18,23,24), but these variations could result from the retrospective nature of the studies.…”

The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy

“… 15 Only ASAP multifocality seems to be systematically related to a higher risk of a positive re-biopsy. 16 Androgen hormones are necessary for the development, maintenance, and activity of the prostate gland. 7 …”

Atypical small acinar proliferation and its significance in pathological reports in modern urological times

“…[ 47 ] noted that repeat biopsy directed only to the site of atypia on initial biopsy would have missed 53% of cancer cases, whereas Aglamis et al. [ 48 ] observed that cancer was detected in 67% of ipsilateral adjacent biopsy sites, and in 54% of contralateral biopsies.…”