Abstract
Background
In the era of active surveillance of low- and intermediate-risk prostatic cancer, a reconsideration of the implications of a biopsy report of ASAP and/or HGPIN may be timely.
Aims
We investigated the implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy.
Methods
The rate of re-biopsy and the incidence of carcinoma on repeat biopsy for benign, HGPIN, and ASAP groups were compared. Mean PSA and PSA velocity was also compared between groups.
Results
There was an increased risk of developing prostate cancer in the following 5 years with a biopsy diagnosis of ASAP compared to benign (20% vs 5.9%, p = 0.009), and with a biopsy of HGPIN compared with benign (14.8% vs 5.9%, p = 0.005). The frequency of repeat biopsy following a diagnosis of ASAP (54.2%) vs. HGPIN (37%) was not significantly different (p = 0.079). The risk of developing prostate cancer was highest following a biopsy with concomitant ASAP and HGPIN compared to benign (50% vs 5.9%, p < 0.001). There was no significant difference in PSA values between the 3 diagnostic groups at the time of initial biopsy (p = 0.206).
Conclusion
The findings of this study suggest that a biopsy diagnosis of ASAP ± HGPIN, on either initial or surveillance biopsy, provides support for earlier repeat mpMRI and/or re-biopsy. This may assist in directing to early re-biopsy those patients likely to have intermediate- and high-risk prostate cancer.
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References
Sung H et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249
Ireland NCR (2016) Available from: https://www.ncri.ie/publications/cancer-trends-and-projections/cancer-trends-30-prostate-cancer
Adamczyk P et al (2014) Significance of atypical small acinar proliferation and extensive high-grade prostatic intraepithelial neoplasm in clinical practice. Cent European J Urol 67(2):136–141
Tolkach Y, Kristiansen G (2018) Is high-grade prostatic intraepithelial neoplasia (HGPIN) a reliable precursor for prostate carcinoma? Implications for clonal evolution and early detection strategies. J Pathol 244(4):389–393
Epstein JI, Herawi M (2006) Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol 175(3 Pt 1):820–834
Herawi M et al (2006) Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. J Urol 175(1):121–124
Schlesinger C, Bostwick DG, Iczkowski KA (2005) High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: predictive value for cancer in current practice. Am J Surg Pathol 29(9):1201–1207
Gallo F et al (2008) Prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN): risk of prostatic cancer on repeat biopsies. Urology 72(3):628–632
Van der Kwast TH et al (2010) Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies. Am J Surg Pathol 34(2):169–177
Iczkowski KA et al (2002) Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy. Urology 60(5):851–854
Leone L et al (2014) Biopsy follow-up in patients with isolated atypical small acinar proliferation (ASAP) in prostate biopsy. Arch Ital Urol Androl 86(4):332–335
Borboroglu PG et al (2001) Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J Urol 166(3):866–870
Gakis G et al (2013) ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 63(1):45–57
Carroll PR et al (2014) Prostate cancer early detection, version 1.2014. Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 12(9):p 1211–9; quiz 1219
Imanaka T et al (2020) Implementation of repeat biopsy and detection of cancer after a diagnosis of atypical small acinar proliferation of the prostate. Mol Clin Oncol 13(6):67
Prathibha S, Goyal KG, Zynger DL (2018) Initial diagnosis of insignificant cancer, high-grade prostatic intraepithelial neoplasia, atypical small acinar proliferation, and negative have the same rate of upgrade to a Gleason score of 7 or higher on repeat prostate biopsy. Hum Pathol 79:116–121
Bostwick DG, Meiers I (2006) Atypical small acinar proliferation in the prostate: clinical significance in 2006. Arch Pathol Lab Med 130(7):952–957
Ynalvez LA et al (2018) Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm. Int Urol Nephrol 50(1):1–6
Draisma G et al (2009) Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst 101(6):374–383
Jahn JL, Giovannucci EL, Stampfer MJ (2015) The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the prostate-specific antigen-era. Int J Cancer 137(12):2795–2802
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O’Connor, E., Dowling, C., Casey, M. et al. Implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy: a 5-year follow-up study. Ir J Med Sci 191, 2035–2040 (2022). https://doi.org/10.1007/s11845-021-02854-2
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DOI: https://doi.org/10.1007/s11845-021-02854-2