Prognostic Significance of High Grade Prostatic Intraepithelial Neoplasia and Atypical Small Acinar Proliferation in the Contemporary Era

Moore, Courtenay; Karikehalli, Shridevi; Nazeer, Tipu; Fisher, Hugh A.G.; Kaufman, Ronald P.; Mian, Badar M.

doi:10.1097/01.ju.0000148260.69779.c5

Cited by 123 publications

(96 citation statements)

References 19 publications

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“…Because of the high cancer detection rates, a repeat biopsy should be performed in cases where ASAP is detected. It has been reported that in ASAP cases where the cancer detection rate is high following a repeat biopsy, the regions where ASAP occurred in the initial biopsy should be overemphasized (7,8). According to another study, cancer was detected in 84.8% of cases where a repeat biopsy was performed on the former biopsy area, and in 47.8% of cases where ipsilateral adjacent and contralateral biopsies were performed.…”

Section: Discussionmentioning

confidence: 99%

“…ASAP without any findings of malignancy was noted in 5.1% of the results of the initial prostate biopsies. ASAP is described as the presence of atypical glands not diagnostic of prostate cancer, and/or the absence of definitive architectural or cytological features of carcinoma (7,9). A repeat biopsy was performed on patients in whom ASAP was identified in the initial biopsy and who accepted a repeat biopsy.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, repeat biopsies should be performed in these cases. The cancer detection rates in repeat biopsies of these cases vary between 19-38% (7,8). The core number of the repeat biopsy and the area in which it should be performed has frequently been the subject of research.…”

Section: Introductionmentioning

confidence: 99%

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How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

Aglamis

Kocaarslan

Yücetaş³

et al. 2014

Int. braz j urol.

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ARTICLE INfO ______________________________________________________________ ______________________Objective: To compare cancer detection rates according to the number of biopsy cores in patients on whom a repeat prostate biopsy was performed for atypical small acinar proliferation (ASAP). Materials and Methods:The data of 4950 consecutive patients on whom prostate biopsies were performed were assessed retrospectively. A total of 107 patients were identified as having ASAP following an initial prostate biopsy, and they were included in the study. A six-core prostate biopsy (PBx) was performed on 15 of the 107 patients, 12 PBx on 32 patients, and 20 PBx on 60 patients. Cancer detection rates were compared according to the number of biopsy cores. The localization of the cancer foci was also evaluated.Results: The cancer detection rates in patients on whom 6 PBx, 12 PBx, and 20 PBx were performed were 20% (3/15), 31% (10/32), and 58% (35/60), respectively, and a statistically significant difference was found (p = 0.005). When cancer detection rates in patients with total prostate specific antigen (PSA) < 10ng/mL, PSA density ≥ 0.15, normal digital rectal examination, and prostate volume ≥ 55mL were compared according to the number of biopsy cores, a significant difference was identified (p = 0.02, 0.03, 0.006, and 0.04, respectively). Seventy-five percent of the foci where cancer was detected were at the same and/or adjacent sites as the ASAP foci in the initial biopsy, and 54% were identified in contralateral biopsies in which ASAP foci were present. Conclusion: As the biopsy core number increases, the cancer detection rate increases significantly in patients on whom a repeat biopsy is performed due to ASAP. The highest cancer rate is found in 20-core repeat biopsies performed equally from all foci.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

Aglamis

Kocaarslan

Yücetaş³

et al. 2014

Int. braz j urol.

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show abstract

“…[6][7][8][9] However, some clinical studies showed that patients with HGPIN have a low risk of further cancer diagnosis but not higher than that observed in cases with a benign diagnosis. [10][11][12][13][14] In any case, after the introduction of extended bioptic schemes with 10/12 samples, the rate of cancer diagnosis after HGPIN decreased from the values up to 80% of the sextant biopsy era to the current 20-30%; probably, owing to a wider sampling, the diagnoses at rebiopsy that were previously not detected at the initial biopsy were avoided. 15 Therefore, it is still debated whether it is really necessary to repeat a biopsy for all the patients with HGPIN and EAU guidelines, 16 generically suggest an early rebiopsy only for multifocal HGPIN.…”

Section: Resultsmentioning

confidence: 99%

Predicting prostate cancer at rebiopsies in patients with high-grade prostatic intraepithelial neoplasia: a study on 546 patients

Antonelli

Tardanico

Giovanessi

et al. 2011

Prostate Cancer Prostatic Dis

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The aim of this study was to analyse the factors that predict the diagnosis of prostate cancer (PCa) after high-grade prostatic intraepithelial neoplasia (HGPIN). Data from 546 patients with HGPIN submitted up to a 6-month series of three rebiopsies, according to an institutional protocol, were reviewed. PCa has been found in 174 cases (31.8%), in 116 cases at the first and in 58 cases at a further rebiopsy. The risk of finding PCa at the first rebiopsy was correlated with the PSA value and with an anomalous digital rectal examination (DRE) at the time of the initial biopsy; the risk at a subsequent rebiopsy was correlated to the number of cores with HGPIN, with a cutoff of four, and to the ratio with the total number of cores ('PIN density'), with a cutoff of 50%, at the time of initial biopsy. A tailored protocol of controls can be suggested: (a) higher PSA value and/or anomalous DRE: early extended or saturation rebiopsy; (b) number of cores with HGPIN X4 and/or PIN density X50%: delayed rebiopsy; and (c) no risk factors: PSA and DRE controls.

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“…ASAP is the precancerous lesion most related to PCa (Moore et al, 2005;Amin et al, 2007;Lopez, 2007). By definition, ASAP consists of a focus of small acinar structures formed by atypical epithelial cells and is considered a strong risk factor for PCa.…”

Section: Prostate Cancer Precursorsmentioning

confidence: 99%

Prostate cancer: the need for biomarkers and new therapeutic targets

Felgueiras

Silva

Fardilha

2014

J. Zhejiang Univ. Sci. B

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Prostate cancer (PCa) incidence and mortality have decreased in recent years. Nonetheless, it remains one of the most prevalent cancers in men, being a disquieting cause of men's death worldwide. Changes in many cell signaling pathways have a predominant role in the onset, development, and progression of the disease. These include prominent pathways involved in the growth, apoptosis, and angiogenesis of the normal prostate gland, such as androgen and estrogen signaling, and other growth factor signaling pathways. Understanding the foundations of PCa is leading to the discovery of key molecules that could be used to improve patient management. The ideal scenario would be to have a panel of molecules, preferably detectable in body fluids, that are specific and sensitive biomarkers for PCa. In the early stages, androgen deprivation is the gold standard therapy. However, as the cancer progresses, it eventually becomes independent of androgens, and hormonal therapy fails. For this reason, androgen-independent PCa is still a major therapeutic challenge. By disrupting specific protein interactions or manipulating the expression of some key molecules, it might be possible to regulate tumor growth and metastasis formation, avoiding the systemic side effects of current therapies. Clinical trials are already underway to assess the efficacy of molecules specially designed to target key proteins or protein interactions. In this review, we address that recent progress made towards understanding PCa development and the molecular pathways underlying this pathology. We also discuss relevant molecular markers for the management of PCa and new therapeutic challenges.

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Prognostic Significance of High Grade Prostatic Intraepithelial Neoplasia and Atypical Small Acinar Proliferation in the Contemporary Era

Abstract: HGPIN found in the contemporary extended biopsy does not warrant repeat biopsy. ASAP continues to be associated with a high risk of cancer and requires at least 1 repeat biopsy using the extended biopsy scheme.

Cited by 123 publications

References 19 publications

How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

Predicting prostate cancer at rebiopsies in patients with high-grade prostatic intraepithelial neoplasia: a study on 546 patients

Prostate cancer: the need for biomarkers and new therapeutic targets

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