UroToday - In the September 2008 issue of the Journal of Urology, Dr. Robert Abouassaly and associates from the Cleveland Clinic reported that the finding of atypia on prostate biopsy is associated with a high likelihood of underlying malignancy, regardless of the number of cores taken at the initial biopsy.

The investigators performed this study, because some have suggested that equivocal findings, such as atypia, are due to inadequate prostate sampling at initial biopsy. The group retrospectively determined the risk of prostate cancer (CaP) at repeat biopsy in patients with atypia diagnosed on saturation biopsy. Between 2001 and 2007, a total of 4,139 prostate biopsies were entered into the Cleveland Clinic database, of which 1,068 were saturation. From these, 57 had atypia on initial biopsy and underwent rebiopsy. Nineteen patients had atypia diagnosed on saturation biopsy (20 cores or greater) and 38 had atypia diagnosed using a traditional biopsy technique.

Median patient age was 62 years, median PSA was 5.0ng/ml, and median time between biopsies was 5 months. Eight of 19 patients (42%) were diagnosed with CaP on repeat biopsy, of whom 7 had Gleason score 6 and 1 had Gleason score 10 CaP. Of the 38 men with atypia on initial biopsy, 15 (39%) had CaP on repeat biopsy. Ten men had Gleason score 6, four had Gleason score 7 and 1 had Gleason score 9 CaP. The only difference between the groups was the men with an initial saturation biopsy were more likely to have concomitant inflammation diagnosed on the initial biopsy. Patients with CaP were less likely to have inflammation seen at the initial biopsy; only 5 of 22 men (23%) with inflammation at initial biopsy had CaP on repeat biopsy compared to 18 of 35 (51%) without inflammation.

These data suggest that under-sampling the prostate may not be a factor resulting in the diagnosis of atypia.

Abouassaly R, Tan N, Moussa A, Jones JS
J Urol. 2008 Jul 15. Epub ahead of print.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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