It has long been understood that a finding of “atypia” (atypical small acinar proliferation) on an initial biopsy of the prostate is associated with an increased risk for prostate cancer, and a repeat biopsy is normally recommended for any patient with an initial finding of atypia.
A recent paper by Kopp et al. reports on an analysis of data from a cohort of 139 patients, all of whom were initially diagnosed with atypia and all of whom then underwent the recommended repeat prostate biopsy.
The findings of this clinical research team were as follows:
- Prostate cancer was identified in 41/139 patients (29 percent).
- 26/41 (66 percent) had Gleason 6 disease.
- 8/41 (20 percent) had Gleason 7 disease.
- 3/41 (7 percent) had Gleason 8 disease.
- Gleason scores of < 6 were not reported.
- There was no clear association of a diagnosis of prostate cancer on repeat biopsy with age, race, family history, PSA, PSA density, number of previous biopsies, or time to repeat biopsy.
- Histological inflammation was associated with a major decrease in the probability of cancer on repeat biopsy (odds ratio [OR] = 0.15).
- 14/41 men diagnosed with prostate cancer (31 percent) underwent radical prostatectomy.
- 6/14 (43 percent) had a Gleason score ≥ 7.
- 3/14 (21 percent) had pT3a disease.
- 1/14 (7 percent) had positive lymph nodes.
Kopp et al. conclude that (at least in this cohort of patients) inflammation of the prostate in men diagnosed with atypia was independently associated with a significantly decreased risk of cancer on repeat biopsy. However, a significant percentage of patients with initial atypia clearly are at risk for clinically significant prostate cancer.
It would help if we were able to better determine which patients with an initial finding of atypia were most and least likely to have a subsequent finding of such clinically significant disease.