Rc. Ouyang et al., The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy, BJU INT, 87(1), 2001, pp. 70-74
Objective To determine the clinical significance of nondiagnostic small aci
ni showing cellular atypia (atypical small acinar proliferation) in prostat
ic biopsies of patients with clinical findings suggestive of malignancy.
Patients and methods Of 331 patients who underwent thin-core biopsy of the
prostate over a 30-month period, 21 (6.3%) had atypical histological featur
es, and of these 17 underwent repeat biopsy. In addition, a further 20 pati
ents with normal histology underwent repeat biopsy for persistent abnormal
clinical findings. The incidence and Gleason score of carcinomas subsequent
ly diagnosed in the two groups were compared. The predictive significance o
f patient age, prostate specific antigen (PSA) level and digital rectal exa
mination (DRE) findings were compared between both patient groups, those in
each group subsequently found to have carcinoma, and between patients with
malignant or normal repeat biopsies who had either atypical or normal init
ial biopsies.
Results Nine patients with atypical histology and four with normal histolog
y on initial biopsy were found to have carcinoma on subsequent biopsy (P =
0.036). The site of carcinoma diagnosed in the repeat biopsy frequently dif
fered from that of the initial atypical biopsy. The Gleason primary pattern
was not significantly different between the groups. Neither patient age, P
SA level nor DRE findings differed between patients with initial normal or
atypical biopsy, or in these groups for those in whom carcinoma was subsequ
ently diagnosed. These clinical features did not distinguish between those
with carcinoma or normal findings on repeat biopsy who had an initial atypi
cal biopsy, while only PSA level varied significantly in patients with norm
al or malignant repeat biopsy in the group with an initial normal biopsy,
Conclusion The presence of atypia on initial biopsy is a strong predictor o
f malignancy in subsequent biopsy specimens.