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Atypical small acinar proliferation (ASAP) and prostatic intraepitelial neoplasia (PIN) as precancerous lesions in patients with suspicion and prostate cancer
Article published in Urologia Polska 2008/61/3.

authors

Przemysław Adamczyk, Zbigniew Wolski, Romuald Butkiewicz, Joanna Nussbeutel, Zdzisław Skok, Wojciech Jóźwicki
Oddział Urologii Ogólnej i Onkologicznej Specjalistycznego Szpitala Miejskiego w Toruniu
Katedra i Klinika Urologii Ogólnej, Onkologicznej i Dzieci Collegium Medicum Uniwersytetu Mikołaja Kopernika w Bydgoszczy
Zakład Patomorfologii Specjalistycznego Szpitala Miejskiego w Toruniu
Katedra i Zakład Patomorfologii Collegium Medicum Uniwersytetu Mikołaja Kopernika w Bydgoszczy

keywords

atypical small acinar proliferation (ASAP) Prostatic Intraepitelial Neoplasia (PIN) precancerous lesions of prostate cancer

summary

Introduction.

Association of high grade prostatic intraepitelial neoplasia (HG-PIN) and atypical small acinar proliferation (ASAP) with cancer development is still not clear, particularly in case of ASAP. The aim of the study. The aim of the was to establish a prevalence of precancerous lesions, and prostate cancer in patients followed first and subsequen

Material and method.

In study, 928 males were included, in which 6-12 core, transrectal ultrasound guided prostate biopsy
was preformed. In patients with ASAP or PIN in first biopsy, or suspected for cancer development, second biopsy (extended to 10-16 cores) was preformed in period of 4-6 months.

Results.

Prostate cancer was found in 300 (32.3%) patients, and precancerous lesions (ASAP, HG-PIN) in 135 (14.54%), from which ASAP in 50 (5.38%), HG-PIN in 68 (7.32%) and its co-existence in 17 (1.83%). Co-existence of cancer and ASAP was found in 12 (4%) of 300 males, and HG-PIN and cancer in 24 (8%), with statistical difference. Mean PSA level was no different in ASAP and HG-PIN groups. Following biopsy was performed in 78 patients, founding cancer in 11 (14.1%), from which 4 out of 15 (26.6%) of patients with HG-PIN on first biopsy, and 3 out of 40 (7.5%) with BPH, and 4 out of 19 (21.05%) with ASAP, or ASAP co-existing with LG-PIN, and 1 out of 2 (50%) with co-existence of ASAP and HG-PIN on first biopsy. There was no cancer found on second biopsy, in patients with LG-PIN on first, as well as when prostate inflammation accompanied other lesion. Cancer found in following biopsy in patients with HG-PIN on first, had usually higher Gleason score (7-10), than those found in patients with ASAP on first (score 4-6).

Conclusions.

1. Patients with ASAP or HG-PIN on initial biopsy are similarly suspected to develop prostate cancer.
2. Co-incidence of prostate cancer and HG-PIN was higher than cancer and ASAP.
3. There was no incidence of cancer found on following biopsy in patients with LG-PIN on first, as well as any other lesion combined together with prostate inflammation.
4. PSA level in ASAP and HG-PIN were not significantly different, and usually were higher than 10 ng/ml.

references

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correspondence

Przemysław Adamczyk
Specjalistyczny Szpital Miejski
Oddział Urologii Ogólnej i Onkologicznej
ul. Batorego 17/19
87-100 Toruń
tel. (056) 610 02 54
przemekad@poczta.onet.pl