Risk of Prostatic Carcinoma Following a Diagnosis of Atypical Small Acinar Proliferation: A Multicenter Retro-Respective Study.
Manal Y Gabril, Bassem Moussa, Sherin Metias, Madeleine S Moussa, George M Yousef. London Health Sciences Center/ University of Western Ontario, ON, Canada; St Michael's Hospital/University of Toronto, ON, Canada
Background: The clinical significance of the diagnosis of Atypical Small Acinar Proliferation (ASAP) is questionable. Though previous studies showed that ASAP has high predictive value for prostatic adenocarcinoma (Pca) in subsequent biopsies, still the follow up of these cases is a matter of controversy. In this study, we aim to investigate the incidence of Pca after initial diagnosis of ASAP. Also, we elucidate the criteria of adenocarcinoma developed after that ASAP diagnosis.
Design: 127cases of needle core prostate biopsy with isolated initial diagnosis of ASAP (with at least one subsequent follow up biopsy) at London Health Sciences Center and St. Michael's Hospital, Ontario, Canada, were included in this study (2000-2008). All slides from the cases were re-reviewed by uropathologists. The number of cores with ASAP, age, serum PSA, prostate volume, abnormal DRE, number of biopsy cores in the initial biopsy and also in re-biopsy specimens were evaluated. Clinico-pathological features were assessed in radical prostatectomy specimens for the 40 pateint who developed Pca after ASAP (Cancer volume, Gleason score, extraprostatic status, margins status, seminal vesicles invasion and laterality).
Results: Out of 127 cases with initial diagnosis of ASAP, 40 cases developed Pca. In univariate and multivariate analyses, PSA level was a significant predictor for predicating the presence of prostate cancer in cases with initial diagnosis of ASAP (p = 0.26 and p = 0.095 respectively). There was a statistically significant correlation between the site of ASAP and the site of developing carcinoma on follow-up biopsies (p = 0.019). Data extracted from radical prostatectomies for developed Ca showed cancer volume was > 5% (64.7%) and <5% in (35.3%) and Gleason score was 3+3 = 6/10 in 77% and 7/10 in rest of cases with comparable results of these parameters on initial core biopsies. No evidence of extraprostatic extension, seminal vesicles invasion or lymph nodes metastasis in all 40 cases was confirmed.
Conclusions: Our study showed that ASAP diagnosis is a significant predictor of subsequent Pca, and re-biopsy should be considered in these cases. Pca developed after a diagnosis of ASAP can have a more than a minimal cancer volume but has low tumor stage.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 77, Wednesday Morning