Diagnostic criteria for ASAP :
For pathologists, 3 questions need to be answered before the diagnosis of cancer in a small lesion:
• Would you be absolutely confident of this biopsy diagnosis if it were followed by a negative radical prostatectomy?
• Would another colleague pathologist agree with the diagnosis of cancer?
• Can you confidently support the diagnosis of adenocarcinoma based solely on this biopsy?
If the answer to any of these questions is “No,” then use of the more conservative diagnosis of ASAP is recommended.
Reasons for the Diagnosis of ASAP are :
- Small number of acini in the focus of concern.
- Small focus size, average 0.4 mm in diameter.
- Loss of focus of concern in deeper levels.
- Distortion of acini raising concern for atrophy.
- Lack of convincing features of cancer (insufficient nucleomegaly or nucleolomegaly).
- Foamy cytoplasm raising concern for foamy gland carcinoma.
- Conflicting immunohistochemical findings.
Significance of ASAP. -
Prostate cancer is found in up to 60% of repeat biopsies after the diagnosis of ASAP. Thus
ASAP in a biopsy is a significant predictor for concurrent or subsequent cancer. The high predictive value of atypical small acinar proliferation (ASAP) for subsequent adenocarcinoma indicates a need for repeat biopsy.
References:
2. Cheville JC, Reznicek MJ, Bostwick DG. The focus of “atypical glands,suspicious for malignancy” in prostatic needle biopsy specimens: incidence,histologic features, and clinical follow-up of cases diagnosed in a community practice. Am J Clin Pathol. 1997;108:633– 640.
3. Iczkowski KA, Bassler TJ, Schwob VS, et al. Diagnosis of “suspicious for malignancy” in prostate biopsies: predictive value for cancer. Urology.1998;51:749 –757; discussion 757–748.
4. Isabelle Meiers, at el. Atypical Small Acinar Proliferation in the prostate :Pathology Case reviews • Volume 13, Number 4, July/August 2008;13: 129–134
4 comments:
Some more information:
High grade PIN with adjacent small atypical glands (PINATYP)
May be difficult to determine if small glands represent budding / tangentially sectioned glands from high-grade PIN or invasive cancer next to high grade PIN; no reliable differentiating features
Risk of cancer on repeat biopsy was 46%, higher than high grade PIN alone, indicating patients should be rebiopsied.
I have read your earlier post on ASAP many times & it is reassuring. My worry is:
We get only 1-2 cores in a trucut; it is non TRUS-guided. A rpt bx may / may not be helpful. How often does a TURP help in such cases ? As Ca is supposed to be more commonly involving the peripheral region of the prostate, would a TURP help esp. if the pt. has severe obstructive symptoms ? I have posted a query recently on patho-l; you may like to look at it.
Best regards,Sandhya.
Hello Dr. Sandhya,
Thanks for your comment.
In patients with previously negative biopsies, the diagnostic yield of TURP is low. Therefore, TURP for diagnostic purposes only cannot be recommended. However, in patients with an abnormal DRE and obstructive symptoms, surgery should be preferred over alternative treatment options.
Reference:
Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies
Urology, Volume 62, Issue 5, Pages 883-887
Thank you.
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