Mp49-10 Who Can Safely Avoid Repeat Prostate Biopsy Following the Detection of Atypical Small Acinar Proliferation?

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-10 WHO CAN SAFELY AVOID REPEAT PROSTATE BIOPSY FOLLOWING THE DETECTION OF ATYPICAL SMALL ACINAR PROLIFERATION? Masatomo Kaneko, Divyangi Paralkar, Lorenzo Storino Ramacciotti, Giovanni E. Cacciamani, Manju Aron, Michelle Hopstone, Vinay Duddalwar, Inderbir S. Gill, and Andre Luis Abreu Masatomo KanekoMasatomo Kaneko , Divyangi ParalkarDivyangi Paralkar , Lorenzo Storino RamacciottiLorenzo Storino Ramacciotti , Giovanni E. CacciamaniGiovanni E. Cacciamani , Manju AronManju Aron , Michelle HopstoneMichelle Hopstone , Vinay DuddalwarVinay Duddalwar , Inderbir S. GillInderbir S. Gill , and Andre Luis AbreuAndre Luis Abreu View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To find predictors of clinically significant cancer (CSPCa, ISUP grade group [GG] ≥2) detection on the follow-up (FU) prostate biopsy (PBx) after the detection of atypical small acinar proliferation (ASAP). METHODS: From our prospectively maintained PBx database (IRB# HS-13-00663), patients whose baseline PBx detected ASAP without concomitant prostate cancer (PCa) were identified. Inclusion criteria: I) no previous history of PCa; II) No prior surgery for BPH. All patients underwent FU-PBx within 2 years after baseline PBx. Uni- and multivariable analyses were performed to identify the independent predictors of CSPCa detection. The performance of the multivariable model was assessed in terms of the receiver operating characteristics (ROC) and at the optimal cutoff point determined by Youden's index. Statistical significance was defined as p<0.05. RESULTS: A total of 124 patients met the inclusion criteria. Overall, 30% were diagnosed with CSPCa on the 1st FU-PBx. The distribution of GG on the FU-PBx were, benign 44%, GG1 27%, GG2 17%, GG3 5.7%, GG4 5.7%, and GG5 1.6%. Baseline characteristics of men with vs without CSPCa were; median age (65 vs 64, p=0.04), family history of PCa (24 vs 28%, p=0.7), history of benign PBx results (49 vs 46%, p=0.8), PSA (5.8 vs 5.3ng/ml, p=0.6), PSA density (PSAD, 0.20 vs 0.10ng/ml2, p=0.001), prostate volume (PV, 36 vs 55 cc, p=0.01), suspicion for PCa on digital rectal examination (DRE, 11 vs 18%, p=0.3), and Prostate Imaging-Reporting and Data System (PIRADS) score 3-5 (86 vs 62%, p=0.2), respectively. At baseline, PSAD was the sole independent predictor of CSPCa detection (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.38); however, the number of ASAP cores was not a predictor. Among the variables just before the 1st follow-up PBx, age (OR 1.13, 95% CI 1.04-1.24), PV (OR 0.96, 95% CI 0.93-0.98), and PIRADS 3-5 (OR 6.32, 95% CI 1.73-23.16) were the independent predictors of CSPCa detection. The area under the ROC curve of this follow-up variables model achieved the highest predictive performance of 0.82. At the optimal cutoff point, the sensitivity and specificity were 74% and 80%, respectively. Using this model, 80% of patients without CSPCa could safely avoid unnecessary FU-PBx, achieving a negative predictive value of 84%. CONCLUSIONS: Men with ASAP should be followed by MRI to assess the risk of clinically significant prostate cancer. Selected young men with a large prostate and PIRADS 1-2 may safely avoid unnecessary follow up prostate biopsy. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e786 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Masatomo Kaneko More articles by this author Divyangi Paralkar More articles by this author Lorenzo Storino Ramacciotti More articles by this author Giovanni E. Cacciamani More articles by this author Manju Aron More articles by this author Michelle Hopstone More articles by this author Vinay Duddalwar More articles by this author Inderbir S. Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...