Leslie A Ynalvez1, Christopher D Kosarek1, Preston S Kerr1, Ali M Mahmoud1, Eduardo J Eyzaguirre2, Eduardo Orihuela1, Joseph N Sonstein1, Stephen B Williams3. 1. Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA. 2. Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA. 3. Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA. stbwilli@utmb.edu.
Abstract
PURPOSE: Guidelines for atypical small acinar proliferation (ASAP) diagnosed on prostate biopsy recommend repeat biopsy within 3-6 months after diagnosis. We sought to discern the rate of detecting clinically significant prostate cancer on repeat biopsy and predictors associated with progression. MATERIALS AND METHODS: We performed a retrospective chart review of patients who underwent prostate biopsy at our institution from January 1, 2008, to December 31, 2015. Gleason grade group (GGG) system and D'Amico stratification were used to report pathology and risk stratification, respectively. Logistic and linear regression analyses were performed. RESULTS: A total of 593 patients underwent transrectal ultrasound-guided prostate biopsy, of which 27 (4.6%) had the diagnosis of ASAP. Of these, 11 (41%) had a repeat biopsy. Median time from diagnosis to repeat biopsy was 147 days (IQR 83.5-247.0). Distribution across the GGG system on repeat biopsy was as follows: 7 (63.6%) benign, 3 (27.3%) GG1, and 1 (9.1%) GG2. ASAP was not associated with subsequent diagnosis of clinically significant prostate cancer (OR 0.46, 95% CI 0.064-3.247, P = 0.432). There was no association between ASAP and high cancer risk (ASAP: β = - 0.12; P = 0.204). CONCLUSIONS: Patients diagnosed with ASAP managed according to guideline recommendations are more likely diagnosed with benign pathology and indolent prostate cancer on repeat biopsy. These findings support prior studies suggesting refinement of guidelines in regard to the appropriateness and timeliness of repeat biopsy among patients diagnosed with ASAP.
PURPOSE: Guidelines for atypical small acinar proliferation (ASAP) diagnosed on prostate biopsy recommend repeat biopsy within 3-6 months after diagnosis. We sought to discern the rate of detecting clinically significant prostate cancer on repeat biopsy and predictors associated with progression. MATERIALS AND METHODS: We performed a retrospective chart review of patients who underwent prostate biopsy at our institution from January 1, 2008, to December 31, 2015. Gleason grade group (GGG) system and D'Amico stratification were used to report pathology and risk stratification, respectively. Logistic and linear regression analyses were performed. RESULTS: A total of 593 patients underwent transrectal ultrasound-guided prostate biopsy, of which 27 (4.6%) had the diagnosis of ASAP. Of these, 11 (41%) had a repeat biopsy. Median time from diagnosis to repeat biopsy was 147 days (IQR 83.5-247.0). Distribution across the GGG system on repeat biopsy was as follows: 7 (63.6%) benign, 3 (27.3%) GG1, and 1 (9.1%) GG2. ASAP was not associated with subsequent diagnosis of clinically significant prostate cancer (OR 0.46, 95% CI 0.064-3.247, P = 0.432). There was no association between ASAP and high cancer risk (ASAP: β = - 0.12; P = 0.204). CONCLUSIONS:Patients diagnosed with ASAP managed according to guideline recommendations are more likely diagnosed with benign pathology and indolent prostate cancer on repeat biopsy. These findings support prior studies suggesting refinement of guidelines in regard to the appropriateness and timeliness of repeat biopsy among patients diagnosed with ASAP.
Entities:
Keywords:
Atypical small acinar proliferation (ASAP); Prostate biopsy; Prostate cancer
Authors: Dima Raskolnikov; Soroush Rais-Bahrami; Arvin K George; Baris Turkbey; Nabeel A Shakir; Chinonyerem Okoro; Jason T Rothwax; Annerleim Walton-Diaz; M Minhaj Siddiqui; Daniel Su; Lambros Stamatakis; Pingkun Yan; Jochen Kruecker; Sheng Xu; Maria J Merino; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: J Urol Date: 2014-08-20 Impact factor: 7.450
Authors: Rodolfo Montironi; Vincenzo Scattoni; Roberta Mazzucchelli; Antonio Lopez-Beltran; David G Bostwick; Francesco Montorsi Journal: Eur Urol Date: 2006-08-10 Impact factor: 20.096
Authors: Donna P Ankerst; Josef Hoefler; Sebastian Bock; Phyllis J Goodman; Andrew Vickers; Javier Hernandez; Lori J Sokoll; Martin G Sanda; John T Wei; Robin J Leach; Ian M Thompson Journal: Urology Date: 2014-06 Impact factor: 2.649
Authors: Jeffrey J Tosoian; Bruce J Trock; Patricia Landis; Zhaoyong Feng; Jonathan I Epstein; Alan W Partin; Patrick C Walsh; H Ballentine Carter Journal: J Clin Oncol Date: 2011-04-04 Impact factor: 44.544
Authors: Derek W Cool; Cesare Romagnoli; Jonathan I Izawa; Joseph Chin; Lori Gardi; David Tessier; Ashley Mercado; Jonathan Mandel; Aaron D Ward; Aaron Fenster Journal: Can Urol Assoc J Date: 2016 Sep-Oct Impact factor: 1.862
Authors: Jonathan I Epstein; Lars Egevad; Mahul B Amin; Brett Delahunt; John R Srigley; Peter A Humphrey Journal: Am J Surg Pathol Date: 2016-02 Impact factor: 6.394
Authors: D A Kapoor; I W Klimberg; G H Malek; J D Wegenke; C E Cox; A L Patterson; E Graham; R M Echols; E Whalen; S F Kowalsky Journal: Urology Date: 1998-10 Impact factor: 2.649