Skip to main content
SpringerLink
Log in

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

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30

    Article  PubMed  Google Scholar 

  2. Makarov DV, Trock BJ, Humphreys EB et al (2007) Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology 69(6):1095–1101

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lu-Yao GL, Albertsen PC, Moore DF et al (2009) Outcomes of localized prostate cancer following conservative management. JAMA 302(11):1202–1209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mohler JL, Armstrong AJ, Bahnson RR et al (2016) Prostate cancer, version 1.2016. J Natl Compr Cancer Netw 14(1):19–30

    Article  Google Scholar 

  5. Montironi R, Scattoni V, Mazzucchelli R, Lopez-Beltran A, Bostwick DG, Montorsi F (2006) 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 50(4):666–674

    Article  CAS  PubMed  Google Scholar 

  6. Borboroglu PG, Comer SW, Riffenburgh RH, Amling CL (2000) Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol 163(1):158–162

    Article  CAS  PubMed  Google Scholar 

  7. Moore CK, Karikehalli S, Nazeer T, Fisher HA, Kaufman RP Jr, Mian BM (2005) Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J Urol 173(1):70–72

    Article  PubMed  Google Scholar 

  8. Warlick C, Feia K, Tomasini J, Iwamoto C, Lindgren B, Risk M (2015) Rate of Gleason 7 or higher prostate cancer on repeat biopsy after a diagnosis of atypical small acinar proliferation. Prostate Cancer Prostatic Dis 18(3):255–259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Leone A, Gershman B, Rotker K et al (2016) Atypical small acinar proliferation (ASAP): is a repeat biopsy necessary ASAP? A multi-institutional review. Prostate Cancer Prostatic Dis 19(1):68–71

    Article  CAS  PubMed  Google Scholar 

  10. Dorin RP, Wiener S, Harris CD, Wagner JR (2015) Prostate atypia: does repeat biopsy detect clinically significant prostate cancer? Prostate 75(7):673–678

    Article  PubMed  Google Scholar 

  11. Tosoian JJ, Mamawala M, Epstein JI et al (2015) Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol 33(30):3379–3385

    Article  PubMed  PubMed Central  Google Scholar 

  12. Carroll PR, Parsons JK, Andriole G et al (2014) Prostate cancer early detection, version 1.2014. Featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 12(9):1211–1219 (quiz 1219)

    Article  CAS  Google Scholar 

  13. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA (2016) The 2014 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40(2):244–252

    PubMed  Google Scholar 

  14. Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137

    Article  PubMed  Google Scholar 

  15. van Vugt HA, Roobol MJ, Kranse R et al (2011) Prediction of prostate cancer in unscreened men: external validation of a risk calculator. Eur J Cancer 47(6):903–909

    Article  PubMed  Google Scholar 

  16. Ankerst DP, Hoefler J, Bock S et al (2014) Prostate cancer prevention trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer. Urology 83(6):1362–1367

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hamdy FC, Donovan JL, Lane JA et al (2016) 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375(15):1415–1424

    Article  PubMed  Google Scholar 

  18. Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29(16):2185–2190

    Article  PubMed  Google Scholar 

  19. Raskolnikov D, Rais-Bahrami S, George AK et al (2015) The role of image guided biopsy targeting in patients with atypical small acinar proliferation. J Urol 193(2):473–478

    Article  PubMed  Google Scholar 

  20. Cool DW, Romagnoli C, Izawa JI et al (2016) Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation. Can Urol Assoc J 10(9–10):342–348

    Article  PubMed  PubMed Central  Google Scholar 

  21. Merrick GS, Galbreath RW, Bennett A, Butler WM, Amamovich E (2016) Incidence, grade and distribution of prostate cancer following transperineal template-guided mapping biopsy in patients with atypical small acinar proliferation. World J Urol 35:1009–1013

    Article  PubMed  Google Scholar 

  22. Kapoor DA, Klimberg IW, Malek GH et al (1998) Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology 52(4):552–558

    Article  CAS  PubMed  Google Scholar 

  23. Ekwueme DU, Stroud LA, Chen Y (2007) Cost analysis of screening for, diagnosing, and staging prostate cancer based on a systematic review of published studies. Prev Chronic Dis 4(4):A100

    PubMed  PubMed Central  Google Scholar 

  24. Ploussard G, Plennevaux G, Allory Y et al (2009) 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 27(5):587–592

    Article  PubMed  PubMed Central  Google Scholar 

  25. Aus G, Ahlgren G, Bergdahl S, Hugosson J (1996) Infection after transrectal core biopsies of the prostate—risk factors and antibiotic prophylaxis. Br J Urol 77(6):851–855

    Article  CAS  PubMed  Google Scholar 

  26. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ (2012) Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 61(6):1110–1114

    Article  PubMed  Google Scholar 

  27. Lundstrom KJ, Drevin L, Carlsson S et al (2014) Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol 192(4):1116–1122

    Article  PubMed  Google Scholar 

  28. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM (2013) Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol 189(3):867–870

    Article  PubMed  Google Scholar 

  29. Nam RK, Saskin R, Lee Y et al (2013) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 189(1 Suppl):S12–S17 (discussion S17–18)

    Article  PubMed  Google Scholar 

  30. Borboroglu PG, Sur RL, Roberts JL, Amling CL (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

    Article  CAS  PubMed  Google Scholar 

  31. Epstein JI, Zelefsky MJ, Sjoberg DD et al (2016) A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 69(3):428–435

    Article  PubMed  Google Scholar 

  32. Rosenkrantz AB, Verma S, Choyke P et al (2016) Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 196(6):1613–1618

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health (SBW).

Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA

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

  2. Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Eduardo J. Eyzaguirre

Authors
  1. Leslie A. Ynalvez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher D. Kosarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Preston S. Kerr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali M. Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eduardo J. Eyzaguirre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eduardo Orihuela
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joseph N. Sonstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stephen B. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen B. Williams.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained from individual participants included in the study as the study was a retrospective study which institutional IRB granted waiver for consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ynalvez, L.A., Kosarek, C.D., Kerr, P.S. et al. Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm. Int Urol Nephrol 50, 1–6 (2018). https://doi.org/10.1007/s11255-017-1714-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1714-8

Keywords

Search

Navigation