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Tsampoukas G, Manolas V, Brown D, Dellis A, Deliveliotis K, Moussa M, Papatsoris A. Atypical small acinar proliferation and its significance in pathological reports in modern urological times. Asian J Urol 2021; 9:12-17. [PMID: 35198392 PMCID: PMC8841244 DOI: 10.1016/j.ajur.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/11/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports, suggestive but not definitive for cancer. The terminology corresponds to some uncertainty in the biopsy report, as the finding might represent an underlying non-cancerous pathology mimicking cancer or an under-sampled prostate cancer site. Therefore, traditional practice favors an immediate repeat biopsy. However, in modern urological times, the need of urgent repeat biopsy is being challenged by some authors as in the majority of cases, the grade of cancer found in subsequent biopsy is reported to be low or the disease to be non-significant. On the other hand, high risk disease cannot be excluded, whereas no clinical or pathological factors can predict the final outcome. In this review, we discuss the significance of the diagnosis of atypical small acinar proliferation in the biopsy report, commenting on its importance in modern urological practice.
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Affiliation(s)
- Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Corresponding author. U-merge Ltd. (Urology for Emerging Countries), London, UK.
| | - Victor Manolas
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
- Department of Urology, Broomfield Hospital, Chelmsford, UK
| | - Athanasios Dellis
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology and General Surgery, Areteion Hospital, Athens, Greece
| | - Konstantinos Deliveliotis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Moussa
- Chairman of Surgery & Urology Department, Lebanese University & Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Srirangam V, Rai BP, Abroaf A, Agarwal S, Tadtayev S, Foley C, Lane T, Adshead J, Vasdev N. Atypical Small Acinar Proliferation and High Grade Prostatic Intraepithelial Neoplasia: Should We Be Concerned? An Observational Cohort Study with a Minimum Follow-Up of 3 Years. Curr Urol 2017; 10:199-205. [PMID: 29234263 DOI: 10.1159/000447181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction Atypical small acinar proliferation (ASAP) and high grade prostatic intraepithelial neoplasia (HGPIN) are considered precancerous. We aimed to measure the rate of repeat biopsy and adenocarcinoma in patients with ASAP and HGPIN and identify any clinico-pathologic parameters at diagnosis of ASAP/HGPIN that are predictive of adenocarcinoma. Materials and Methods Patients with a diagnosis of ASAP/HGPIN with no previous or concomitant cancer were identified. Prostate specific antigen (PSA) and magnetic resonance imaging (MRI) changes were monitored. Re-biopsy was at clinician discretion. Results Nineteen were diagnosed with ASAP and 17 with HGPIN. Seven with ASAP (37%) and 6 with HGPIN (35%) underwent re-biopsy. Three (16%) with ASAP and 5 with HGPIN (29%) were diagnosed with adenocarcinoma. The difference in cancer detection rates between ASAP and HGPIN was not significant (p = 0.35). Five (14%) in total required definitive therapy for adenocarcinoma. Twenty-three (64%) did not undergo repeat biopsy. Parameters at diagnosis of HGPIN and ASAP, including PSA, prostate volume and PSA density, were compared between the cancer and non-cancer cohorts with none found to be predictive of adenocarcinoma. Conclusion By monitoring PSA and MRI changes, we managed to spare re-biopsy in two-thirds of patients. Further evaluation is necessary to characterize a surveillance protocol in these populations.
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Affiliation(s)
| | - Bhavan Prasad Rai
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Ahmed Abroaf
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | | | - Sergey Tadtayev
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Charlotte Foley
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Tim Lane
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Jim Adshead
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
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Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol 2017; 15:55-66. [PMID: 28858331 DOI: 10.1038/nrurol.2017.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate biopsy is the gold standard for diagnosing prostate cancer and reliable pathological assessment is essential for guiding management. Research efforts over the past few years have aimed to establish a more universal approach to management according to pathological grading; however, high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands suspicious for carcinoma are two diagnoses without standardized follow-up and treatment pathways. Much of this uncertainty is due to limited evidence describing the subsequent rates of cancer and high-grade cancer when HGPIN or atypical glands are detected on initial biopsy. Fortunately, data from the past decade have shed light on these phenomena, and an improved understanding of the implications of the presence of HGPIN and atypical glands on prostate biopsy means that clinical recommendations can be made for the management of patients with these diagnoses.
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Affiliation(s)
- Jeffrey J Tosoian
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Mark W Ball
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - H Ballentine Carter
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg 2242, Baltimore, Maryland 21231, USA
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Sanguedolce F, Cormio A, Musci G, Troiano F, Carrieri G, Bufo P, Cormio L. Typing the atypical: Diagnostic issues and predictive markers in suspicious prostate lesions. Crit Rev Clin Lab Sci 2017; 54:309-325. [PMID: 28828885 DOI: 10.1080/10408363.2017.1363155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As much as 5% of prostate biopsies yield findings equivocal for malignancy even for skilled uropathologist; such "grey zone" lesions have been addressed in many ways, although the acronym ASAP (atypical small acinar proliferation) is the most widely used when referring to an atypical focus suspicious, but not diagnostic, for malignancy. Since the introduction of this diagnostic category more than 20 years ago, debate has ensued over its histological characterization and clinical significance. Pathology reporting of ASAP, commonly based on strict morphological criteria and traditional immunohistochemical markers such as basal cell antibodies, has been improved by recent availability of novel immunohistochemical markers such as AMACR and ERG. Further pathological issues, such as the role of pre-analytical variables, number of tissue levels, interobserver variability, and association with prostatic intraepithelial neoplasia also play a role in the optimal assessment of ASAP. Apart from diagnostic issues, a major issue is ASAP predictive value for prostate cancer on repeat biopsy. Therefore, attempts have been made to identify clinical and biological parameters that could predict subsequent diagnosis of malignancy as well as define time and modality of repeat biopsy. Finally, pathological features of cancers detected after a previous ASAP diagnosis are compared with those diagnosed at first prostate biopsy.
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Affiliation(s)
| | - Antonella Cormio
- b Department of Biosciences, Biotechnologies, and Biopharmaceutics , University of Bari , Bari , Italy
| | - Giovanni Musci
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Francesco Troiano
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Giuseppe Carrieri
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Pantaleo Bufo
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Luigi Cormio
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
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Burks FN, Hu JC, Telang D, Liu A, Hawken S, Montgomery Z, Linsell S, Montie JE, Miller DC, Ghani KR. Repeat Prostate Biopsy Practice Patterns in a Statewide Quality Improvement Collaborative. J Urol 2017; 198:322-328. [DOI: 10.1016/j.juro.2017.02.3338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Frank N. Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Jonathan C. Hu
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Dinesh Telang
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Alice Liu
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Scott Hawken
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Zack Montgomery
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Susan Linsell
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - James E. Montie
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - David C. Miller
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Khurshid R. Ghani
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
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Kumar NB, Patel R, Pow-Sang J, Spiess PE, Salup R, Williams CR, Schell MJ. Long-term supplementation of decaffeinated green tea extract does not modify body weight or abdominal obesity in a randomized trial of men at high risk for prostate cancer. Oncotarget 2017; 8:99093-99103. [PMID: 29228755 PMCID: PMC5716795 DOI: 10.18632/oncotarget.18858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/03/2017] [Indexed: 01/28/2023] Open
Abstract
Background Evidence continues to demonstrate the role of obesity in prostate carcinogenesis and prognosis, underscoring the need to identify and continue to evaluate the effective interventions to reduce obesity in populations at high risk. The aim of the study was to determine the effect of daily consumption of decaffeinated green tea catechins (GTC) formulation (Polyphenon E® (PolyE)) for 1 year on biomarkers of obesity in men who are at high risk for prostate cancer. Materials and Methods A randomized, double-blinded trial was conducted targeting 97 men diagnosed with HGPIN or ASAP. Subjects were randomized to receive GTC (PolyE) (n = 49) or placebo (n = 48) for 1 year. Anthropometric data were collected at baseline, 6 and 12 months and data analyzed to observe change in weight, body mass index (indicator of obesity) and waist: hip ratio (indicator of abdominal obesity). Results Decaffeinated GTC containing 400 mgs of the bioactive catechin, EGCG administered for 1 year to men diagnosed with ASAP and HGPIN appears to be bioavailable, well tolerated but not effective in reducing biomarkers of obesity including body weight, body mass index and waist: hip ratio. Conclusions The results of our trial demonstrates that men who are obese and at high risk for prostate cancer should resort to effective weight management strategies to reduce obesity and not resort to ineffective measures such as taking supplements of green tea to reduce biomarkers of obesity. Changes in body mass index and abdominal obesity seen in other studies were potentially due to caffeine and not GTC.
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Affiliation(s)
- Nagi B Kumar
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/CANCONT, Tampa, FL 33612, USA
| | - Roshni Patel
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/CANCONT, Tampa, FL 33612, USA
| | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center and Research Institute, Inc., WCB-GU PROG, Tampa, FL 33612, USA
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center and Research Institute, Inc., WCB-GU PROG, Tampa, FL 33612, USA
| | - Raoul Salup
- James A Haley Veterans Hospital, Tampa, FL 33612, USA
| | - Christopher R Williams
- Urologic Oncology, Research, and Robotic Surgery, University of Florida and Shands Medical Center, Jacksonville, FL 32209, USA
| | - Michael J Schell
- H. Lee Moffitt Cancer Center and Research Institute, Inc., MRC/BIOSTAT, Tampa, FL 33612, USA
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Scott Libby R, Kramer JJ, Tue Nguyen HM, Feibus A, Thomas R, Silberstein JL. Racial Variation in the Outcome of Subsequent Prostate Biopsies in Men With an Initial Diagnosis of Atypical Small Acinar Proliferation. Clin Genitourin Cancer 2017; 15:e995-e999. [PMID: 28566201 DOI: 10.1016/j.clgc.2017.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/06/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND African American (AA) men are known to have more aggressive prostate cancer (PCa) compared with Caucasian American men. We sought to determine predictors of subsequent detection and risk stratification of PCa in a racially diverse group of men with atypical small acinar proliferation (ASAP) on initial prostate biopsy. MATERIALS AND METHODS A retrospective analysis was conducted on data from men with ASAP on initial prostate biopsy who subsequently received confirmatory biopsies between September 2000 and July 2015. Biopsies with more than 3 years between initial and confirmatory biopsies were excluded. Race, age, body mass index, transrectal ultrasound volume, serum prostate-specific antigen (PSA), PSA velocity, PSA density, and elapsed time between biopsies were assessed for predictive value in subsequent PCa diagnosis after an initial finding of ASAP. RESULTS Of 106 men analyzed, 75 (71%) were AA and 31 (29%) were non-AA. Baseline variables revealed AA men had higher PSA levels, PSA velocity, and PSA density (all P < .05). PCa was diagnosed in subsequent biopsy in 42 (40%) patients without significant racial variation; 30 (40%) AA versus 12 (39%) non-AA. Of the 42 PCa patients, 25 (24%) met Epstein criteria for significant disease without racial variation; 18 (24%) AA versus 7 (23%) non-AA. Only 10 (9%) patients had any component of Gleason 4; 7 (9%) AA versus 3 (10%) non-AA. In multivariate analysis, increasing age, PSA level, and PSA density were significant predictors of PCa. CONCLUSION AA men diagnosed with ASAP on initial prostate biopsy do not have increased risk of PCa on confirmatory biopsy compared with non-AA men.
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Affiliation(s)
- Robert Scott Libby
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Jordan J Kramer
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Hoang Minh Tue Nguyen
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Allison Feibus
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Raju Thomas
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Jonathan L Silberstein
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA.
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Kowalewski A, Szylberg Ł, Skórczewska A, Marszałek A. Diagnostic Difficulties With Atrophy, Atypical Adenomatous Hyperplasia, and Atypical Small Acinar Proliferation: A Systematic Review of Current Literature. Clin Genitourin Cancer 2016; 14:361-365. [PMID: 26992486 DOI: 10.1016/j.clgc.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/29/2016] [Accepted: 02/14/2016] [Indexed: 11/25/2022]
Abstract
Prostate cancer is the second leading cause of cancer death in men, behind only lung cancer. In some cases, the proper diagnosis of prostatic neoplasia can be challenging, and the differential diagnosis includes atypical nonmalignant lesions such as atrophy, atypical adenomatous hyperplasia (AAH), and atypical small acinar proliferation (ASAP). Atrophy and AAH have a benign clinical outcome, and if detected on needle biopsy or transurethral resection of the prostate, clinical follow-up seems appropriate. In contrast, ASAP cannot be determined to be benign or malignant. In clinical practice, the diagnosis of ASAP is an indication for repeat biopsy because the chance of finding prostate adenocarcinoma is even greater than that with an earlier diagnosis of high-grade prostatic intraepithelial neoplasia. Malignant lesions require more restrictive treatment; therefore, differentiation among atrophy, AAH, ASAP, and adenocarcinoma is essential. We performed a systematic review of the current data allow to the creation of a diagnostic algorithm for atrophy, AAH, ASAP, and adenocarcinoma. We propose an algorithm that covers the practical issues related to interpretation of the biopsy findings and how to proceed further.
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Affiliation(s)
- Adam Kowalewski
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
| | - Łukasz Szylberg
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Anna Skórczewska
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Andrzej Marszałek
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; Department of Oncologic Pathology and Prophylactics, Poznan University of Medical Sciences and Department of Oncologic Pathology, Greater Poland Cancer Center, Poznan, Poland
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