Immediate repeat prostate biopsy may be unnecessary for most men with atypical small acinar proliferation (ASAP), researchers concluded.
ASAP occurs in about 5% of prostate biopsies, and prostate cancer (PCa) develops in approximately 30%–40% of men with ASAP within 5 years, according to a report in Prostate Cancer and Prostatic Diseases (published online ahead of print). Current guidelines recommend a repeat biopsy within 3–6 months after initial diagnosis.
Andrew Leone, MD, a genitourinary oncology fellow at Moffitt Cancer Center in Tampa, Fla., and colleagues studied a retrospective cohort of 264 men who underwent prostate biopsy and received a diagnosis of ASAP. All patients underwent repeat biopsy. Subjects had a median follow-up of 5.4 years. Of these patients, 89 (34%) were subsequently diagnosed with PCa. Only 21 of these (8% of the entire cohort) had high-grade cancer. The men diagnosed with PCa had significantly higher median PSA levels prior to biopsy than those not diagnosed with PCa (6.7 vs. 5.8 ng/mL).
“Given the potential morbidity of prostate biopsy, which includes pain, bleeding, urinary difficulties and infectious complications and the increasing prevalence of antimicrobial resistance,our findings suggest that current guideline recommendations for immediate repeat biopsy within 3–6 months represent overtreatment for most men with ASAP,” the authors wrote.
Instead, Dr. Leone’s team noted, such patients may be best managed according to current active surveillance paradigms, including surveillance with PSA tests and digital rectal examinations and consideration of additional evaluation with ancillary imaging modalities such as magnetic resonance imaging or emerging diagnostic tests.