Atypical small acinar proliferation Review of a series of 64 patients

Abstract

Objective. To study the evolution of 64 patients initially diagnosed with ASAP (atypical small acinar proliferation). Material and methods. Between 1998 and the end of 2003, 64 patients were diagnosed at our centre with ASAP. Results. The mean age of the patients assessed was 69 years (SD 6.4 years), the median prostate-specific antigen (PSA) level was 7.1 ng/ml (range 2–39 ng/ml) and 25% of the patients had a suspicious rectal examination. These 64 patients were subjected to re-biopsy. At re-biopsy, we diagnosed 27 patients (42%) with prostate adenocarcinoma. We classified patients into two groups depending on whether they did (n=27) or did not (n=37) have tumours. There were no significant differences in median PSA level between the two groups. The rectal examination was suspicious in 14% of patients without tumours and in 39% with tumours. Radical prostatectomy was applied to 20/28 patients (71%) diagnosed with prostate cancer. In these 20 patients, the median tumour volume was 0.4 cm³ (range 0.1–3.2 cm³) and 44% of the tumours were significant. The 37 patients with an unsuspicious histology were subjected to follow-up for a median of 12 months (range 1–30 months). The median PSA level in these patients was 5.7 ng/ml (range 0.8–28 ng/ml). A third biopsy was performed in three of these patients in view of an elevated PSA level, and one result was positive. Conclusions. In our experience, a pathological result of ASAP is associated with a definitive diagnosis of prostate cancer in 42% of cases. Moreover, a significant cancer was found in 44% of patients subjected to radical prostatectomy. We therefore systematically perform repeat biopsies on all patients with a histological result of ASAP.

• Prostate cancer
• atypical small acini
• diagnosis