einstein. 2009; 7(4 Pt 1):411-4
Prostate biopsies containing prostate intraepithelial neoplasia and atypical small acinar prolieration: what to do?
Most epidemiologic studies evaluating HGPINand ASAP as risk actors or PCa were rom a time when sextant biopsies (six samples) were routinelyperormed
. Nowadays, the minimum numberconsidered or a proper PCa screening is 12 samples(extended biopsy). In this context, recent studies havedemonstrated that the incidence o HGPIN and ASAPis dierent rom the previously stated, as well as the risko a subsequent diagnosis o PCa
.Our study has some important fndings. First, theincidence o HGPIN on prostate biopsy was o 4.6%,reproducing the results o recent studies on extendedbiopsies
. HGPIN was associated with a 38.5% chanceo PCa detection in repeated biopsies, and there wasa signifcant lower risk o detecting cancer in thetopography o previous HGPIN
80%; p = 0.036). However, this risk must alsobe compared to the risk o fnding cancer in a repeatedbiopsy ater a benign diagnosis, which ranges rom 10.0to 30.0%
. Other series diagnosed PCa in 10 to57%
o repeated biopsies ater HGPIN
. Inthe present series with extended biopsies, the diagnosiso PCa was made in 13.2 to 30.5%
. We ound ahigher rate o PCa than these authors, and a higher ratethan ater benign diagnosis, but still lower than observedor ASAP. Thereore, urther studies evaluating otheractors, such as the number o involved cores andmorphologic patterns, might help to determine whicho the men with HGPIN are at signifcantly higherrisk o harboring carcinoma and would beneft romrebiopsies
.Second, ASAP occurred in 1.4% o the extendedprostate biopsies, what is also similar to larger series
. The risk o diagnosing PCa on repeated biopsies waso 53.6%, comparable to recent series (range rom 37.0to 51.0%)
. There was also a signifcant higher risk o detecting the PCa close to the site o ASAP (p = 0.001;OR = 10.8). Thereore, patients with ASAP at prostatebiopsies are at increased risk o uture PCa detection,and it is recommended that ASAP oci should be moreextensively sampled on repeated biopsies. As the risko PCa is higher in patients with ASAP, it is generallyrecommended that rebiopsies are taken ater three tosix months
.Third, or patients who had ASAP in the frst biopsy,the risk o detecting PCa was 50.0%. However, in allcases (n = 3) in which ASAP was ound only ater thesecond biopsy, a subsequent biopsy diagnosed PCa. Although there were ew cases o association HGPIN + ASAP, this fnding seems to be related to an even higherrate o uture detection o PCa than isolated HGPIN or ASAP, as previously reported
.Our study has several limitations. Even though alarge number o biopsies were evaluated (6,490), thenumber o patients with HGPIN and ASAP was muchlower. Thereore, the relatively small number o men orsubsequent analysis limits the power o the study. Also,it is important to note that a high subset o patients werelost to ollow-up and did not undertake rebiopsy aterHGPIN or ASAP, which can raise a concern o ollow-up bias. However, the strength o our study is that alarge number o patients in a contemporary extendedbiopsy series could be evaluated.
In conclusion, ollowing the fnding o HGPIN or ASAP on extended prostate biopsies, close ollow-up is recommended, and repeated biopsies should beperormed according to clinical data. Rebiopsies shouldbe strongly recommended when the association HGPIN+ ASAP is present or when ASAP is ound only aterthe second biopsy. Repeated biopsies ater an ASAPfnding should be always randomized, but oci o ASAPfnding should be more extensively sampled.
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