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Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume

Authors Nakai Y, Tanaka N, Miyake M, Hori S, Tatsumi Y, Morizawa Y, Fujii T, Konishi N, Fujimoto K

Received 5 August 2017

Accepted for publication 2 September 2017

Published 21 September 2017 Volume 2017:9 Pages 187—193


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Jan Colli

Yasushi Nakai,1 Nobumichi Tanaka,1 Makito Miyake,1 Shunta Hori,1 Yoshihiro Tatsumi,1,2 Yosuke Morizawa,1 Tomomi Fujii,2 Noboru Konishi,2 Kiyohide Fujimoto1

1Department of Urology, Nara Medical University, 2Department of Pathology, Nara Medical University, Kashihara-shi, Nara, Japan

The objective of this study was to evaluate whether high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) predict prostate cancer (PCa) during repeat transperineal template saturation biopsy with a high number of cores per prostate volume in patients with persistent clinical suspicion of PCa who underwent at least one previous negative transrectal ultrasound (TRUS)-guided biopsy.
Methods: We retrospectively evaluated 135 consecutive patients with persistent clinical suspicion of PCa, despite a set of negative TRUS-guided biopsies and increasing prostate-specific antigen levels; abnormal findings on digital rectal examination, TRUS, or magnetic resonance imaging; previous biopsy showing HGPIN; and previous biopsy showing atypical glands. Transperineal template saturation biopsy (TTSB) was performed at 5mm intervals to sample one core for each 1 mL of prostate volume. 
Results: The median rate of biopsy cores per prostate volume was 1.00 (range: 0.75–1.39). The PCa detection rates in patients who were diagnosed with HGPIN, or had two or more cores of HGPIN or ASAP, were 53% (9/17), 89% (8/9), and 83% (10/12), respectively. Two or more HGPIN cores and ASAP were positive predictors of PCa on TTSB. The high-grade cancer rates (Gleason score [GS] ≥7) in patients with ASAP and two or more cores of HGPIN were 20% and 80%, respectively. The cancer detection rate represented by a GS score ≥8 in patients with ASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy was 5.5% (1/18).
ASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy strongly indicated the presence of PCa on TTSB.

Keywords: atypical small acinar proliferation, high-grade intraepithelial neoplasia, transperineal template-guided saturation biopsy, prostate cancer, repeat biopsy

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