Su Rui, Ye Shi-Jie, Wang Su-Ying, Zhang Zhou-Liang, Chen Hui-Ping, Zhang Hui-Zhi, Li Chang, Zhao Ming, Fei Xin, Yan Ze-Jun, Ma Qi
Comprehensive Genitourinary Cancer Center, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China.
Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China.
BMC Cancer. 2025 May 28;25(1):964. doi: 10.1186/s12885-025-14366-8.
To investigate the clinical outcomes and diagnostic strategies for patients with atypical small acinar hyperplasia (ASAP) in their initial prostate biopsy in a real-world setting.
A retrospective analysis was conducted on the data of 170 patients who received their first prostate biopsy result as ASAP. The lost follow-up rate, clinical interventions, subsequent pathological results, prostate cancer detection rate, and Gleason scores were analyzed. Furthermore, subgroup analysis was performed on cases with repeat biopsies.
Of the 170 patients, 45 were lost to follow-up, with a dropout rate of 26.5%. Among the remaining 125 patients, 68 did not receive clinical intervention. Meanwhile, 57 underwent clinical interventions during follow-up, including 50 with repeat biopsies (50 second-time biopsies, 8 third-time biopsies, and 2 fourth-time biopsies), 3 underwent transurethral resection of prostate (TURP), and 4 had radical surgeries. In total, 28 were diagnosed with prostate cancer, diagnoses included 22 cases from prostate biopsies, 2 from TURP, and 4 from radical surgeries. Of the 22 biopsy-confirmed prostate cancer cases, 17 underwent radical surgeries at our hospital. Postoperative pathology revealed that 71.4%(5/7) of the cases upgraded from clinically insignificant cancer to clinically significant cancer. Ultimately, clinically significant prostate cancer accounted for 85.7%(24/28) of all positive cases and 42.1%(24/57) of the clinically intervened cases. Further subgroup analysis revealed that biopsy groups 6-12 months post-initial ASAP diagnosis had a noticeably higher positive rate than those biopsied within 6 months.
For the patients with ASAP diagnosed by the initial biopsy, the risk of subsequent diagnosis of clinically significant prostate cancer is high. Combined with the high dropout rate and postoperative pathological escalation rate in this study cohort, it is recommended that patients with ASAP be given high priority in clinical practice, and repeated biopsy is recommended to be carried out within 6-12 months.
在真实临床环境中，研究初次前列腺穿刺活检诊断为非典型小腺泡增生（ASAP）患者的临床结局及诊断策略。
对170例初次前列腺穿刺活检结果为ASAP的患者数据进行回顾性分析。分析失访率、临床干预措施、后续病理结果、前列腺癌检出率及Gleason评分。此外，对重复穿刺活检的病例进行亚组分析。
170例患者中，45例失访，失访率为26.5%。其余125例患者中，68例未接受临床干预。同时，57例在随访期间接受了临床干预，包括50例行重复穿刺活检（50例第二次穿刺活检、8例第三次穿刺活检、2例第四次穿刺活检），3例行经尿道前列腺切除术（TURP），4例行根治性手术。共28例诊断为前列腺癌，其中22例来自前列腺穿刺活检，2例来自TURP，4例来自根治性手术。22例经穿刺活检确诊的前列腺癌患者中，17例在我院接受了根治性手术。术后病理显示，71.4%（5/7）的病例从临床意义不显著的癌症升级为临床意义显著的癌症。最终，临床意义显著的前列腺癌占所有阳性病例的85.7%（24/28），占接受临床干预病例的42.1%（24/57）。进一步亚组分析显示，初次ASAP诊断后6 - 12个月的穿刺活检组阳性率明显高于6个月内穿刺活检的组。
对于初次穿刺活检诊断为ASAP的患者，后续诊断为临床意义显著的前列腺癌的风险较高。结合本研究队列中的高失访率和术后病理升级率，建议在临床实践中对ASAP患者给予高度重视，并建议在6 - 12个月内进行重复穿刺活检。
