Clinical Follow-Up of Patients with Initial ASAP Biopsy Reclassified by a Urologic Pathologist as Benign, ASAP or Cancer: Does “Accurate” Interpretation Have Clinical Relevance?
Michael G Keeney, John K Schoolmeester, Ryan E Swapp, Brant A Inman, Christine M Lohse, Thomas J Sebo. Mayo Clinic, Rochester, MN
Background: ASAP on prostate biopsy (bx) is a descriptive diagnosis (dx) intended to guide clinical management. Greater than 90% of urologists consider ASAP sufficient for re-bx and close follow-up. ASAP encompasses a wide variety of lesions that contain neither a sufficient number of glands nor cytologic or architectural atypia to establish a definitive dx. The clinical significance of ASAP dx is linked to its increased risk of carcinoma (Ca) detection on re-bx, but long-term outcome of patients (pts) diagnosed with ASAP is uncertain.
Design: 96 pts with an ASAP bx between 1994 and 2005 were identified in our instiutional archives. Clinical and pathologic features of these bxs were retrospectively reviewed by an experienced urologic pathologist (UP) and ASAP foci were either kept as ASAP or reclassified as benign or Ca.
Results: ASAP was reclassified as ASAP in 55 (57%), benign in 30 (31%) and Ca in 11 (11%) cases. Eighty-nine pts had vital status information following ASAP bx available for review. Mean pt age was 65.8 years (range 40-85). 16 pts died of other causes at mean of 6.8 years following ASAP bx (range 1.1-12.5). Mean duration of follow-up for remaining 73 pts still alive was 8.6 years (range 0.2-16.8). Estimated overall survival rate (95% CI; number still at risk) at 10 years following ASAP bx was 81% (71-91;30). Only one pt died of prostate Ca. Among subset of 89 pts, there were 26, 52, and 11 with re-review dx of benign, ASAP and Ca, respectively, of whom 4, 10, and 2 died during follow-up. Estimated overall survival rates (95% CI; number still at risk) at 10 years following ASAP bx were 90% (77-100;10), 78% 965-92;16), and 71% (43-100;4) for pts with re-review dx of benign, ASAP, and Ca, respectively (p=0.89; Figure). Although re-review by UP restratified patient risk of Ca on follow-up bx from 17% in benign re-review group to 43% in ASAP group to 75% in Ca group (p<0.01), this had no impact on overall clinical outcome.
Conclusions: Re-review by urologic pathologist for “accurate” reclassification of prostate bx initially classified as ASAP significantly re-stratified risk of detecting Ca on repeat bx, but failed to show any difference in outcome based upon 10 year survival data.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 152, Wednesday Afternoon