Abstract
Background:
Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30–40% of patients with ASAP may develop prostate cancer (PCa) within a 5-year period. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. Our objective was to examine the association between ASAP and subsequent diagnosis of high-grade PCa and to evaluate the need for immediate repeat biopsy.
Methods:
A retrospective multi-institutional review identified 264 patients who underwent prostate biopsy from 2000 to 2013 (Brown), 2008 to 2013 (University of Massachusetts) and 1994 to 2005 (Mayo) and were diagnosed with ASAP. Patients underwent transrectal ultrasound-guided biopsies for elevated PSA and/or abnormal digital rectal exam. Clinicopathologic features were assessed, including rates of subsequent PCa detection of any high-grade (Gleason 7–10) PCa. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology.
Results:
All 264 patients included underwent repeat biopsy with a median follow-up of 5.4 years (interquartile range: 4.6, 6.7). Of these patients, 89 (34%) were subsequently diagnosed with PCa including 21 (8%) with high-grade PCa. Pre-biopsy PSA was higher among patients subsequently diagnosed with (6.7 vs 5.8, P<0.001). Of those diagnosed with subsequent PCa, 69/89 (78%) had less than or equal to Gleason 3+3 disease and only 15/89 (17%) had Gleason 7 and 6/89 (6%) revealed Gleason ⩾8–10. Radical prostatectomy was performed on 36/89 (40%) patients. Surgical pathology revealed 11 patients ⩾Gleason 8–10 PCa.
Conclusions:
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Montironi R, Scattoni V, Mazzucchelli R, Lopez-Beltran A, Bostwick DG, Montorsi F . Atypical foci suspicious but not diagnostic of malignancy in prostate needle biopsies (also referred to as "atypical small acinar proliferation suspicious for but not diagnostic of malignancy"). Eur Urol 2006; 50: 666–674.
Cheville JC, Reznicek MJ, Bostwick DG . The focus of "atypical glands, suspicious for malignancy" in prostatic needle biopsy specimens: incidence, histologic features, and clinical follow-up of cases diagnosed in a community practice. Am J Clin Pathol 1997; 108: 633–640.
Chin AI, Dave DS, Rajfer J . Is repeat biopsy for isolated high-grade prostatic intraepithelial neoplasia necessary? Rev Urol 2007 Summer; 9: 124–131.
Borboroglu PG, Sur RL, Roberts JL, Amling CL . Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J Urol 2001; 166: 866–870.
Scattoni V, Roscigno M, Freschi M, Deho F, Raber M, Briganti A et al. Atypical small acinar proliferation (ASAP) on extended prostatic biopsies: predictive factors of cancer detection on repeat biopsies. Arch Ital Urol Androl 2005; 77: 31–36.
Carroll PR, Parsons JK, Andriole G, Bahnson RR, Barocas DA, Catalona WJ et al. Prostate cancer early detection, version 1.2014. Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2014; 12: 1211–1219.
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65: 124–137.
El-Hakim A, Moussa S . CUA guidelines on prostate biopsy methodology. Can Urol Assoc J 2010; 4: 89–94.
Cooperberg MR, Cowan JE, Hilton JF, Reese AC, Zaid HB, Porten SP et al. Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 2011; 29: 228–234.
Bostwick DG, Meiers I . Atypical small acinar proliferation in the prostate: clinical significance in 2006. Arch Pathol Lab Med 2006; 130: 952–957.
Leone L, Lacetera V, Montironi R, Cantoro U, Conti A, Sbrollini G et al. Biopsy follow-up in patients with isolated atypical small acinar proliferation (ASAP) in prostate biopsy. Arch Ital Urol Androl 2014; 86: 332–335.
Lundstrom KJ, Drevin L, Carlsson S, Garmo H, Loeb S, Stattin P et al. Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol 2014; 192: 1116–1122.
Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM . Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol 2013; 189: 867–870.
van Vugt HA, Roobol MJ, Kranse R, Maattanen L, Finne P, Hugosson J et al. Prediction of prostate cancer in unscreened men: external validation of a risk calculator. Eur J Cancer 2011; 47: 903–909.
Ankerst DP, Hoefler J, Bock S, Goodman PJ, Vickers A, Hernandez J et al. Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer. Urology 2014; 83: 1362–1367.
Moyer VA,, Force USPST. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157: 120–134.
Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010; 183: 963–968.
Tosoian JJ, Trock BJ, Landis P, Feng Z, Epstein JI, Partin AW et al. Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 2011; 29: 2185–2190.
Raskolnikov D, Rais-Bahrami S, George AK, Turkbey B, Shakir NA, Okoro C et al. The role of image guided biopsy targeting in patients with atypical small acinar proliferation. J Urol 2015; 193: 473–478.
Bryant RJ, Sjoberg DD, Vickers AJ, Robinson MC, Kumar R, Marsden L et al. Predicting high-grade cancer at ten-core prostate biopsy using four kallikrein markers measured in blood in the ProtecT study. J Natl Cancer Inst 2015; 107, pii: djv095.
Iczkowski KA, Bassler TJ, Schwob VS, Bassler IC, Kunnel BS, Orozco RE et al. Diagnosis of “suspicious for malignancy” in prostate biopsies: predictive value for cancer. Urology 1998; 51: 749–757; discussion 57–58.
Epstein JI, Herawi M . Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol 2006; 175: 820–834.
Dorin RP, Wiener S, Harris CD, Wagner JR . Prostate atypia: does repeat biopsy detect clinically significant prostate cancer? Prostate 2015; 75: 673–678.
Warlick C, Feia K, Tomasini J, Iwamoto C, Lindgren B, Risk M . Rate of Gleason 7 or higher prostate cancer on repeat biopsy after a diagnosis of atypical small acinar proliferation. Prostate Cancer Prostatic Dis 2015; 18: 255–259.
Ploussard G, Plennevaux G, Allory Y, Salomon L, Azoulay S, Vordos D et al. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on initial 21-core extended biopsy scheme: incidence and implications for patient care and surveillance. World J Urol 2009; 27: 587–592.
Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL,, Committee IG. The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005; 29: 1228–1242.
Chen YB, Pierorazio PM, Epstein JI . Initial atypical diagnosis with carcinoma on subsequent prostate needle biopsy: findings at radical prostatectomy. J Urol 2010; 184: 1953–1957.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Leone, A., Gershman, B., Rotker, K. et al. Atypical small acinar proliferation (ASAP): Is a repeat biopsy necessary ASAP? A multi-institutional review. Prostate Cancer Prostatic Dis 19, 68–71 (2016). https://doi.org/10.1038/pcan.2015.52
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/pcan.2015.52
This article is cited by
-
Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy
Nature Reviews Urology (2018)
-
Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm
International Urology and Nephrology (2018)
-
Incidence, grade and distribution of prostate cancer following transperineal template-guided mapping biopsy in patients with atypical small acinar proliferation
World Journal of Urology (2017)