Implementation of repeat biopsy and detection of cancer after a diagnosis of atypical small acinar proliferation of the prostate

Imanaka, Tadayuki; Yoshida, Takahiro; Taniguchi, Ayumu; Yamanaka, Koji; Kishikawa, Hiroki; Nishimura, Kenji

doi:10.3892/mco.2020.2137

Cited by 6 publications

(7 citation statements)

References 28 publications

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“…Almost half of patients with a biopsy diagnosis of ASAP did not undergo repeat biopsy in the follow-up period. This is not dissimilar to other retrospective studies on the outcomes of ASAP [12,15], which show a similar absence of repeat biopsy in a proportion of cases. Other factors that are likely to play a role in the decision to re-biopsy are PSA level/velocity, PSA density, results of mpMRI, patient age, and indeed patient preference, following discussion with the urologist of all the available information.…”

Section: Discussionsupporting

confidence: 65%

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

et al. 2021

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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). ConclusionThe 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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Section: Discussionsupporting

confidence: 65%

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

et al. 2021

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“…Warlick et al 15 have reported that 17.3% of men have GS ≥ 7 following a TRUS biopsy for ASAP. Yoshida et al 16 reported relatively high csPCa detection rate (13/16 PCa patients, 81.6%) but their study resulted from smaller number of total PCa patients than ours. They indicated that decision making for a repeat biopsy could be affected by clinical characteristics like a small prostate ( p = 0.0250) and advanced age ( p = 0.0297) in real-world settings.…”

Section: Discussioncontrasting

confidence: 62%

Clinical strategy of repeat biopsy in patients with atypical small acinar proliferation (ASAP)

Kim

Choe

et al. 2021

Sci Rep

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Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30–40% of patients with ASAP have biopsy detectable prostate cancer (PCa) within 5 years. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. The aim of the present study was to examine the association between ASAP and subsequent diagnosis of clinically significant PCa (csPCa). The need for immediate repeat biopsy was also evaluated. We identified 212 patients with an ASAP diagnosis on their first biopsy at our institution between February 2006 and March 2018. Of these patients, 102 (48.1%) had at least one follow-up biopsy. Clinicopathologic features including rates of subsequent PCa and csPCa were assessed. Thirty-five patients subsequently underwent radical prostatectomy (RP). Their pathologic results were reviewed. csPCa was defined as the presence of Gleason score (GS) ≥ 3 + 4 in ≥ 1 biopsy core. Adverse pathology (AP) was defined as high-grade (primary Gleason pattern ≥ 4) or non-organ-confined disease (pT3/N1) after RP. Of 102 patients, 87 (85.3%), 13 (12.7%), and 2 (2.0%) had one, two, and three follow-up biopsies, respectively. Median time from the initial ASAP diagnosis to the 2nd follow-up biopsy and the last follow-up biopsy were 21.9 months (range 1–129 months) and 27.7 months (range 1–129 months), respectively. Of these patients, 46 (45.1%) were subsequently diagnosed with PCa, including 20 (19.6%) with csPCa. Only 2 (2.0%) patients had GS ≥ 8 disease. Five (4.9%) patients had number of positive cores > 3. Of 35 patients who subsequently underwent RP, seven (20%) had AP after RP and 17 (48.6%) showed GS upgrading. Of these 17 patients, the vast majority (16/17, 94.1%) had GS upgrading from 3 + 3 to 3 + 4. 45.1% of patients with an initial diagnosis of ASAP who had repeat prostate biopsy were subsequently diagnosed with PCa and 19.6% were found to have csPCa. Our findings add further evidence that after a diagnosis of ASAP, a repeat biopsy is warranted and that the repeat biopsy should not be postponed.

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“…ASAP, a pathological entity defined as the proliferation of small acini without sufficient histological atypia to warrant a definitive diagnosis of prostate adenocarcinoma, is seen in 1.5–9% of primary prostate biopsies [ 16 – 18 ]. The presence of this lesion may be a source of concern for both the pathologist and the urologist in terms of making the correct diagnosis, detecting the cancer and determining follow-up intervals.…”

Section: Discussionmentioning

confidence: 99%

Expression of nectin-4 in prostate cancer

Ordu

2023

North Clin Istanbul

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OBJECTIVE Nectin-4 is a transmembrane protein belonging to the nectin family of immunoglobulin-like molecules which is found in the placenta and trachea under physiological conditions and its expression has been shown in many cancer types. We aimed to investigate for the 1 st time nectin-4 expression in human prostate cancer tissues. METHODS We retrospectively analyzed the prostate pathology specimens of 82 patients who underwent initial transrectal ultrasound-guided prostate biopsy or transurethral prostate resection and were found to have atypical small acinar proliferation (ASAP) and incidentally prostate cancer. Tissue samples with prostatic cancer were used as a control for alpha-methylacyl-CoA racemase (AMACR), and benign prostatic glands in the same tissue provided the negative control. The intensity and extent of nectin-4 expression were determined microscopically using the histochemical scoring system which was defined as the product of the staining intensity (score: 0–3) and percentage of stained cells (0–100) at a given intensity. RESULTS We conducted immunohistochemical analysis of nectin-4 and AMACR expression in all 82 samples. While AMACR expression was positive in prostate cancer tissues with a GS of <7 (n=24, 100%), 7 (n=18, 100%), and ≥8 (n=15, 100%), it was negative in all ASAP samples (n=25, 100%) (p<0.001). Nectin-4 expression was not detected in any of the GS <7, GS 7, or GS ≥8 samples but was found in benign prostatic gland tissues and all 25 (100%) ASAP samples (p<0.001). CONCLUSION We found that nectin-4 was not expressed in prostate cancer tissues but was expressed in ASAP-and benign prostate gland containing tissues. We believe that prospective studies with more patients and samples including radical prostatectomy materials will reveal the relationship between nectin-4 and prostate cancer more clearly.

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Implementation of repeat biopsy and detection of cancer after a diagnosis of atypical small acinar proliferation of the prostate

Cited by 6 publications

References 28 publications

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

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

Clinical strategy of repeat biopsy in patients with atypical small acinar proliferation (ASAP)

Expression of nectin-4 in prostate cancer

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