Predictive Factors For Prostate Cancer
Rates of cancer diagnosed on subsequent prostate biopsies vary according to different reports. However, contemporary studies indicate a mean predictive value for cancer of 39% on repeat biopsy. When an atypical small acinar proliferation diagnosis represents undersampled cancer, the cancer is clinicopathologically similar to cancer diagnosed on first biopsy. Cancer detected on the second or third round of biopsies after an ASAP diagnosis is also similar in grade, stage, and size to cancer detected in control patients in the first biopsy set.
The high predictive value of ASAP for subsequent adenocarcinoma indicates a need for repeat biopsy. Cancer is found in a different sextant site from the initial ASAP site in 39% of patients, suggesting that repeat sampling should include multiple sites of the gland. However, also concentrating repeat biopsy sampling at the site of ASAP, knowing that such foci often represent marginally sampled cancer, may also be prudent.
Scattoni et al found that the number and the location of biopsy cores have an effect on the rates of cancer detection in repeated biopsy settings. According to the authors, after an initial negative biopsy, cancer was detected at rebiopsy in 95 men . Depending on the different combination of sites considered, the cancer detection rates varied significantly.
A study by Warlick et al found that the overall rate of intermediate- and high-grade prostate cancer found on repeat biopsy for ASAP is low.
References
Results Of The First Prostate Biopsy
Among 1,010 men who were subjected to first time biopsy, PCa was diagnosed in 336 patients .
The presence of ASAP and HGPIN lesion were diagnosed in 159 men . The mean value of PSA in the studied men was 19.17 ng/ml . The highest PSA levels were found in the group of patients with PCa and the lowest in the group of patients with lowgrade prostatic intraepithelial neoplasia .
Incidence Of Clinically Significant Prostate Cancer After A Diagnosis Of Atypical Small Acinar Proliferation High
- Tara McLaughlinCorrespondenceAddress correspondence to: Tara McLaughlin, Ph.D., Urology Division, Hartford Healthcare Medical Group, 85 Seymour Street, Suite 416, Hartford, CT 06106.
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What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia
All of these are terms for things that the pathologist might see under the microscope that are benign , but sometimes can look like cancer under the microscope.
Atrophy is a term used to describe a shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.
Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.
What Does It Mean If My Biopsy Report Mentions The Word Core
The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.
Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what’s going on with you.
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Implementation Of Repeat Biopsy And Detection Of Cancer After A Diagnosis Of Atypical Small Acinar Proliferation Of The Prostate
This article is mentioned in:
Abstract
Introduction
Prostate cancer is a significant health concernworldwide. For instance, prostate cancer remains the most commonlydiagnosed solid organ tumor in the United States, with an estimated161,360 new cases and 26,730 deaths in 2016. The incidence of prostate cancer isalso increasing in most Asian countries possibly due to growingimplementation of prostate-specific antigen testing , with the morbidity ranking 4th amongJapanese men in 2014. Prostatecancer comprises a wide spectrum of diseases with some tumors beingindolent and manageable with a monitoring strategy and others beingso aggressive that radical treatments are required to reduce therisk of death from the disease .Therefore, the ideal management of prostate cancer requires anindividualized treatment strategy. As a definitive diagnosis ofprostate cancer is usually made through needle biopsy of theprostate gland, precise differential diagnosis on biopsy specimensto distinguish indolent tumors from aggressive disease is a key tooffering proper management for individual patients to avoid over-or undertreatment of prostate cancer .
Materials and methods
Patient population
Prostate biopsy
PSA kinetics
Statistical analysis
Results
What Does It Mean If My Biopsy Report Mentions Special Tests Such As High Molecular Weight Cytokeratin Ck903 Ck5/6 P63 P40 Amacr 34be12 Pin4 Cocktail Or Erg
These are special tests that the pathologist uses to help decide if your biopsy shows prostate cancer. Not all patients need these tests. Whether or not your report mentions these tests has no effect on the accuracy of your diagnosis. Unfortunately, even with these tests, a biopsy diagnosis of atypia means that it isnt clear if cancer is present or absent.
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What Are The Diagnostic Criteria For Asap
Our inability to render an incontrovertible diagnosis of cancer in a needle biopsy specimen is represented by ASAP. The focus of concern is invariably no larger than 2 dozen aciniless than the size of the head of a pinso the major concern is overdiagnosis of cancer based on insufficient evidence. The quandary in cases in which ASAP is diagnosed usually results from one or a combination of the factors listed in Table 1. All of these factors may hinder a definitive diagnosis of carcinoma, but in such cases, the possibility cannot be definitively excluded . The need for this category is based on our absolute uncertainty regarding the diagnosis. That this need exists is manifested by the variety of terms or synonyms currently in use that include the word atypical to describe this diagnosis, although ASAP is now the preferred term that is most widely used clinically around the world. The diagnosis of ASAP indicates to the clinician that the biopsy specimen in question exhibits histologic features that are neither clearly malignant nor clearly benign and that follow-up of the patient is warranted.
Figure 1.
The 10% frequency of mitotic figures in cancer stands in contrast to that of benign acini. However, mitotic figures are too rare to be a reliable diagnostic finding in small foci.
Moderate to severe atrophy accompanies more cases of ASAP than cancer. Small foci of postatrophic hyperplasia and typical atrophy are sometimes interpreted as ASAP.
Citation Doi & Article Data
Citation:DOI:Dr Amir RezaeeRevisions:see full revision historySystem: Synonyms:
Atypical small acinar proliferations are premalignant lesions of the prostate, which can be found in as many as 5% of prostate biopsies. They are suspicious glands without adequate histologic atypia to establish a definitive diagnosis of prostate cancer. Some studies showed that there is a ~40% chance of findings adenocarcinoma on follow up prostate biopsies.
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Atypical Small Acinar Proliferation: Utility Of Additional Sections And Immunohistochemical Analysis Of Prostatic Needle Biopsies
Braulio MartÃnez-BenÃtez1 , * , Shaddaà Urbina-RamÃrez1
how to cite: Arista-Nasr J, MartÃnez-Mijangos O, MartÃnez-BenÃtez B, Bornstein- Quevedo L, Lino-Silva S, et al. Atypical Small Acinar Proliferation: Utility of Additional Sections and Immunohistochemical Analysis of Prostatic Needle Biopsies. Nephro-Urol Mon. 2012 4: 443-447. doi: 10.5812/numonthly.2067.
Will I Need Treatment For Pin And Asap
You won’t need any treatment for PIN or ASAP, but you might need regular check-ups every few months. This is to check for any cancer cells that may have been missed by biopsy.
You may have:
You might also have an MRI scan to check there’s no cancer in parts of the prostate that weren’t looked at in your biopsy.The tests you have will depend on your own situation. Talk to your doctor or nurse if you have any questions . You can also speak to our Specialist Nurses.If you are diagnosed with cancer, it is more likely to be an early stage because you’ll have had these regular check-ups. This means it can be carefully monitored or treated if necessary.
If you do go on to develop prostate cancer, you won’t have any more check-ups for PIN or ASAP.
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Prostate Biopsy Results: Pin And Asap
PIN and ASAP are changes in the cells in the prostate, which can only be seen under a microscope. PIN stands for prostatic intraepithelial neoplasia. ASAP stands for atypical small acinar proliferation.If you’ve been diagnosed with PIN, it’s probably high-grade PIN. There is also low-grade PIN, but there’s no evidence that this can cause problems in a man’s lifetime. You can check with your doctor if you’re not sure. When we say PIN, we mean high-grade PIN.
Am I More Likely To Get Prostate Cancer If I Have Pin Or Asap
If you have PIN or ASAP, you are more likely to have prostate cancer that wasnt picked up on your first biopsy than a man with no PIN or ASAP.
- 3 in 10 men with a lot of PIN will be diagnosed with prostate cancer after a second biopsy.
- Around 8 in 100 men who have ASAP will be diagnosed with prostate cancer after a second biopsy.
If you’ve been diagnosed with PIN or ASAP and are worried about prostate cancer, speak to your doctor or nurse. Read more about your risk of getting prostate cancer. Or you could speak to one of our Specialist Nurses.
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Atypical Small Acinar Proliferation
| Other names | ASAP |
|---|
In urologicpathology, atypical small acinar proliferation, is a collection of small prostatic glands, on prostatebiopsy, whose significance is uncertain and cannot be determined to be benign or malignant.
ASAP, generally, is not considered a pre-malignancy, or a carcinoma in situ it is an expression of diagnostic uncertainty, and analogous to the diagnosis of ASCUS on the Pap test.
How Common Are Pin And Asap
We dont know how many men in the UK have PIN or ASAP. But for men who have had their prostate tissue looked at under a microscope :
- up to 1 in 20 men have PIN
- around 1 in 50 men have ASAP.
Black men are more likely to get PIN than white men of the same age. Some research also suggests black men may get a larger amount of PIN at an earlier age than white men. But we dont fully understand the reasons for this.
We do know that black men are more likely to get prostate cancer than other men of the same age in the UK. In fact, one in four black men will be diagnosed with prostate cancer. But we still dont know the reasons why. Read more in our leaflet, Prostate cancer and other prostate problems: Information for black men.
There hasnt been any research to look at how likely it is for Asian or mixed-race men to get PIN or ASAP.
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Do I Need A Repeat Biopsy
For men with a biopsy finding that is atypical or suspicious for cancer, follow up is warranted with blood or urine tests, imaging tests and, in some cases, repeat biopsy. The reason that repeat biopsy is not always done is that most of the cancers found following an atypical biopsy are not life threatening. Ask your treating doctor if and when you should have a repeat biopsy.
Questions To Ask Your Doctor Or Nurse
- Have I got high-grade PIN or ASAP?
- How much high-grade PIN or ASAP do I have?
- Do I need further tests to find out more?
- What is my risk of getting prostate cancer?
- How often will I need to have check-ups?
- What will my check-ups involve?
- Will I need to have another biopsy?
- Will I need any other tests?
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What Are The Symptoms Of Pin And Asap
PIN doesnt cause any symptoms. But its usually diagnosed when a man has tests or treatment for another prostate problem that does have symptoms. For example, if you have an enlarged prostate as well as PIN, you might have problems urinating that are caused by the enlarged prostate, not the PIN.
If you are diagnosed with ASAP, the changed cells may or may not be cancer. If they are cancer, they may cause symptoms, such as urinary problems.
If you do have any symptoms such as problems urinating, speak to your doctor. They can do more tests to find out what’s causing them, and suggest treatments that may help.
Atypical Small Acinar Proliferation: Repeat Biopsy And Detection Of High Grade Prostate Cancer
Joseph F. Renzulli
Abstract
Purpose. Atypical small acinar proliferation is diagnosed in 1-2% of prostate biopsies. 3040% of patients with ASAP may be diagnosed with prostate cancer on repeat biopsy. Our objective was to examine the association between ASAP and subsequent diagnosis of intermediate/high risk PCa. Materials and Methods. Ninety-six patients who underwent prostate biopsy from 2000 to 2013 and were diagnosed with ASAP were identified. Clinicopathologic features were analyzed. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology. Results. 56/96 patients had a repeat biopsy. 22/56 were subsequently diagnosed with PCa. There was no significant difference in patients characteristics. Presence of HGPIN on initial biopsy was associated with a benign repeat biopsy . 17/22 had Gleason grade 3+3 disease and only 5/22 had GG 3+4 disease. . 22/56 patients of patients who underwent a subsequent prostate biopsy following a diagnosis of ASAP were found to have PCa. 77% of these men were diagnosed with GG 3+3 PCa. Only 23% were found to have intermediate risk PCa and no high risk PCa was identified. Immediate repeat prostate biopsy in patients diagnosed with ASAP may be safely delayed. A multi-institutional cohort is being analyzed.
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Abbreviations
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What Does It Mean If My Biopsy Report Also Says High
High-grade prostatic intraepithelial neoplasia is considered a pre-cancer of the prostate, because it can turn into prostate cancer over time. Still, the risk of prostate cancer linked to high-grade PIN is lower than the risk of prostate cancer seen with findings atypical or suspicious for cancer. This means that atypical findings in your sample have a greater impact on your cancer risk and future care than a finding of high-grade PIN.
What Is Asap
ASAP stands for atypical small acinar proliferation. ASAP isnt a medical condition but is a term used to describe changes to prostate cells seen under the microscope, when it isnt clear whether the cells are cancer. For example, there may not be enough changed cells for the doctor to say whether they are cancer. If you have ASAP your doctor may recommend more tests so that any further cell changes are found early.
It’s possible to have both ASAP and PIN in your prostate.
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What Is Pin
PIN is not prostate cancer.
PIN stands for prostatic intraepithelial neoplasia. It involves changes to the cells in the prostate. The cells may grow in a different way to normal prostate cells. These changes can only be seen under a microscope.
We don’t know what causes PIN, but we do know that the chance of finding it increases as you get older. Although PIN is not prostate cancer, many men with prostate cancer do have some PIN as well. But most men with PIN dont have prostate cancer and wont go on to develop prostate cancer that needs treating.