Mp19-11 Atypical Small Acinar Proliferation (Asap) in a Prostate Mri Era: Is the Confirmatory Biopsy a Vestige of the Past?

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-11 ATYPICAL SMALL ACINAR PROLIFERATION (ASAP) IN A PROSTATE MRI ERA: IS THE CONFIRMATORY BIOPSY A VESTIGE OF THE PAST? Jared Zopp, Mary Novak, Michael G. Stencel, Stacie Deslich, and Thais Sloop Jared ZoppJared Zopp , Mary NovakMary Novak , Michael G. StencelMichael G. Stencel , Stacie DeslichStacie Deslich , and Thais SloopThais Sloop View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer detection has evolved significantly and MRI has become an integral part of many practices. Atypical small acinar proliferation (ASAP) is a difficult diagnosis to manage, with no clear consensus. Confirmatory biopsy is currently recommended following ASAP diagnosis in order to identify up to 50% of patients harboring undiagnosed prostate cancer. However, it is unclear if MRI has a defined role in the management of patients with previous ASAP diagnosis. METHODS: We performed a single institution, retrospective review of 104 consecutive patients diagnosed with ASAP alone on systematic trans-perineal prostate needle biopsy from January 2017-September 2023. Patients then underwent a confirmatory systematic template biopsy, with or without pre-biopsy magnetic resonance imaging (MRI) of the prostate. Patients with prostate imaging reporting and data system (PI-RADS) lesions ≥3 underwent a targeted biopsy in addition to a systematic biopsy. We measured the cancer detection rate at confirmatory biopsy. RESULTS: A total of 104 patients were diagnosed with ASAP, and 45 underwent confirmatory biopsy after a median of 18 months. Clinically significant prostate cancer (Grade Group 2 or greater) was diagnosed most frequently in patients with pre-confirmatory biopsy MRI showing PI-RADS ≥3 (n=13), followed by patients without pre-confirmatory biopsy MRI (n=13), and was lowest in patients with PI-RADS ≤2 on pre-confirmatory biopsy MRI (n=13) (61.5% v. 15.4% v. 7.7%, p<0.01). CONCLUSIONS: This study investigated the utility of confirmatory biopsy when incorporated with prostate MRI after diagnosis of ASAP and showed that diagnosis of clinically significant prostate cancer at confirmatory biopsy is relatively low when MRI shows PI-RADS ≤2. The data suggest that MRI is a useful adjunct to identify patients that require additional biopsy and may safely reduce the number of unnecessary prostate biopsies. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e314 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jared Zopp More articles by this author Mary Novak More articles by this author Michael G. Stencel More articles by this author Stacie Deslich More articles by this author Thais Sloop More articles by this author Expand All Advertisement PDF downloadLoading ...