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

Leslie A. Ynalvez, Christopher D. Kosarek, Preston S. Kerr, Ali M. Mahmoud, Eduardo Eyzaguirre, Eduardo Orihuela, Joseph Sonstein, Stephen Williams

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInternational Urology and Nephrology
DOIs
StateAccepted/In press - Oct 24 2017

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Prostate
Biopsy
Prostatic Neoplasms
Guidelines
Pathology
Linear Models
Logistic Models
Regression Analysis

Keywords

  • Atypical small acinar proliferation (ASAP)
  • Prostate biopsy
  • Prostate cancer

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Atypical small acinar proliferation at index prostate biopsy : rethinking the re-biopsy paradigm. / Ynalvez, Leslie A.; Kosarek, Christopher D.; Kerr, Preston S.; Mahmoud, Ali M.; Eyzaguirre, Eduardo; Orihuela, Eduardo; Sonstein, Joseph; Williams, Stephen.

In: International Urology and Nephrology, 24.10.2017, p. 1-6.

Research output: Contribution to journalArticle

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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.",
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AU - Mahmoud, Ali M.

AU - Eyzaguirre, Eduardo

AU - Orihuela, Eduardo

AU - Sonstein, Joseph

AU - Williams, Stephen

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AB - 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.

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