BACKGROUND Limited information is known about the clinical significance of cancers diagnosed upon repeat biopsy for the indication of atypical small acinar proliferation (ASAP). With increasing concern regarding overdiagnosis and overtreatment of prostate cancer, and the reported rise in infectious complications related to prostate biopsy, we examined the outcomes of patients rebiopsied for a diagnosis of ASAP. METHODS Clinical, pathologic and outcomes data of patients diagnosed with ASAP on prostate biopsy at our institutions between 2000 and 2010 were abstracted through chart review. Statistical analyses included Fisher's exact and the two-sample Wilcoxon rank sum tests. Logistic regression evaluated risk factors for the probability of cancer following a diagnosis of ASAP. RESULTS A total of 349 patients met the inclusion criteria with median follow-up of 4.4 years. Median age was 65.3 years with a median PSA of 5.3 ng ml(-1). Of men diagnosed with ASAP, 250/349 (71.6%) had a repeat biopsy within 1 year with 94/246 (38.2%) demonstrating prostate cancer; only 26/245 (10.6%) had ⩾Gleason 7 disease. Of men diagnosed with ASAP, 284/349 (81.4%) underwent biopsy at some time during follow-up. Prostate cancer was diagnosed in 132/279 (47.3%) of these men, 48/278 (17.3%) with ⩾Gleason 7 disease. Multivariate analyses suggested that older age, no previous biopsy and PSA density were predictive of cancer on repeat biopsy within 1 year from ASAP. Univariate analysis revealed PSA density was associated with the presence of ⩾Gleason 7 disease at 1 year and any time after a diagnosis of ASAP. CONCLUSIONS The overall rate of intermediate- and high-grade prostate cancer found on repeat biopsy for ASAP is low. Further investigation into ways to further risk stratify these men may be warranted. However, until such tests become available, repeat biopsy of men diagnosed with ASAP remains prudent.

中文翻译：

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诊断为非典型小腺泡增生后，再次活检时格里森7或更高的前列腺癌发生率。

背景技术关于通过重复活检诊断为非典型小腺泡增生（ASAP）的诊断的癌症的临床意义的信息是已知的。随着对前列腺癌过度诊断和过度治疗的关注日益增加，以及与前列腺活检相关的感染并发症的报道有所增加，我们检查了经复活以诊断为ASAP的患者的结局。方法回顾性分析2000年至2010年间在我们机构中经前列腺穿刺活检确诊为ASAP的患者的临床，病理和结局数据。统计分析包括Fisher精确检验和两次样本Wilcoxon秩和检验。Logistic回归评估了ASAP诊断后患癌可能性的风险因素。结果共有349例患者符合纳入标准，中位随访时间为4.4年。中位年龄为65.3岁，中位PSA为5.3 ng ml（-1）。在诊断为ASAP的男性中，有250/349（71.6％）的患者在1年内再次进行了活检，其中94/246（38.2％）的患者表现为前列腺癌。只有26/245（10.6％）的人患有leaGleason 7病。在被诊断为ASAP的男性中，有284/349名（81.4％）在随访期间的某个时间进行了活检。在这些男性中，有132/279（47.3％），48/278（17.3％）患有⩾Gleason7疾病的患者被诊断为前列腺癌。多变量分析表明，年龄大，既往无活检和PSA密度可预测ASAP术后1年内再次进行活检的癌症。单因素分析显示，PSA密度与ASAP诊断1年后任何时间均与⩾Gleason7疾病有关。结论反复进行ASAP活检发现中，高级别前列腺癌的总体发生率较低。可能需要对这些人进行进一步风险分层的方式进行进一步调查。但是，在进行此类检查之前，对被诊断患有ASAP的男性进行再次活检仍是谨慎的。