Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.
Sci Rep. 2021 Nov 30;11(1):23143. doi: 10.1038/s41598-021-02172-8.
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.
非典型小腺泡增生 (ASAP) 约占前列腺活检的 5%。大约 30-40%的 ASAP 患者在 5 年内有可检测到的前列腺癌 (PCa)。目前的指南建议在初始诊断后 3-6 个月内进行重复活检。本研究旨在探讨 ASAP 与随后诊断为临床显著 PCa (csPCa) 的关系。还评估了立即进行重复活检的必要性。我们在 2006 年 2 月至 2018 年 3 月期间在我们的机构对首次活检中诊断为 ASAP 的 212 名患者进行了识别。这些患者中有 102 名 (48.1%) 至少进行了一次后续活检。评估了包括随后发生 PCa 和 csPCa 在内的临床病理特征。35 名患者随后接受了根治性前列腺切除术 (RP)。回顾了他们的病理结果。csPCa 的定义为在至少 1 个活检核心中存在 Gleason 评分 (GS)≥3+4。不良病理 (AP) 定义为 RP 后高分级 (原发性 Gleason 模式≥4) 或非器官受限疾病 (pT3/N1)。在 102 名患者中，87 (85.3%)、13 (12.7%)和 2 (2.0%) 分别进行了一次、两次和三次后续活检。从最初 ASAP 诊断到第 2 次随访活检和最后一次随访活检的中位时间分别为 21.9 个月 (范围 1-129 个月) 和 27.7 个月 (范围 1-129 个月)。这些患者中有 46 名 (45.1%) 随后被诊断为 PCa，其中 20 名 (19.6%) 为 csPCa。只有 2 名 (2.0%) 患者患有 GS≥8 疾病。5 名 (4.9%) 患者阳性核心数>3。在随后接受 RP 的 35 名患者中，有 7 名 (20%) 在 RP 后出现 AP，有 17 名 (48.6%) 显示 GS 升级。在这 17 名患者中，绝大多数 (16/17，94.1%) 从 3+3 升级为 3+4。45.1% 的 ASAP 初始诊断患者进行了重复前列腺活检，随后被诊断为 PCa，19.6% 被诊断为 csPCa。我们的研究结果进一步证明，在 ASAP 诊断后，需要进行重复活检，并且不应推迟重复活检。
