ORLANDO, FL USA (UroToday.com) - Due to their increased risk of prostate cancer (PCa), men who are found to have atypical small acinar proliferation (ASAP) on prostate biopsy are commonly instructed to undergo early re-biopsy. The Prostate Section at the National Cancer Institute questioned the efficacy of re-sampling areas of concern with standard transrectal ultrasound (TRUS) biopsy and sought to demonstrate the ability of MRI/TRUS fusion-guided biopsy to more accurately detect PCa in areas initially diagnosed as ASAP.
The authors reviewed 1 028 patients who underwent multiparametric MRI (MP-MRI) of the prostate followed by MRI/TRUS fusion-guided biopsy. They identified 20 men with no prior PCa diagnosis whose index biopsy pathology demonstrated ASAP and who underwent follow-up MRI/TRUS fusion-guided re-biopsy of the area of concern. Their data suggests that patients diagnosed with solely ASAP after MP-MRI and MRI/TRUS fusion-guided biopsy may not need to return for early re-biopsy, thereby minimizing their exposure to biopsy-related complications.
The authors conclude that rather than early re-biopsy, patients may be able to return for PSA monitoring and repeat MP-MRI, given the high negative predictive value of the non-invasive tool. Additionally, if cancer was found it was often low risk and of arguable clinical significance. The low yield of sampling these areas of concern may provide some respite to patients, deferring the need for early rebiopsy. Considering the fact that in 80% of the cases, the highest-grade pathology in re-targeted cores was found in those areas that were initially labeled as ASAP, this study significantly adds to the growing body of evidence supporting directed sampling.
Presented by Dima Raskolnikov at the American Urological Association (AUA) Annual Meeting- May 16 - 21, 2014 - Orlando, Florida USA
National Cancer Institute, Bethesda, MD USA
Written by Jason T. Rothwax, National Cancer Institute