ATYPICAL SMALL ACINAR PROLIFERATION OF PROSTATE IN PROSTATE NEEDLE BIOPSIES

Atypical small acinar proliferation of prostate refers to small acinar structures that are suspicious of malignancy but lack sufficient
cytological and architectural atypia to establish a definitive diagnosis. The section usually shows a small size of focus with lack of
definite cytologic criteria for malignancy morphologically falling in the gray area between recognizable benign glands and frankly
malignant acini.present study was conducted to know the prevalence of Atypical small acinar proliferation in prostate needle biopsies.
Materials and Methods: Both Prospective study and retrospective study done. Prospective study for 6months i.e from July 2012 to
December 2012 and retrospective study for 2yrs from January 2010 and January 2012 at Kakatiya Medical College/MGM Hospital
Warangal, 14 cases were reported as atypical small acinar proliferation suspicious of malignancy out of 104 Transrectal ultrasound
(TRUS)- guided prostate needle biopsy specimens.
Results: In our study 104 cases have been studied.14(13.4%) cases reported as Atypical Suspicious of malignancy with serum
PSA(Prostate Specific Antigen) levels of 4-32 ng/dl.and remaining cases diagnosed as 28(26.9%) Benign hyperplasia, 6(5.7%) as
chronic inflammation,4(3.8%) as Prostatic intra epithelial neoplasia (PIN),52(50%) as high grade carcinoma.
Conclusion: Atypical foci suspicious of malignancy are seen in 3-5% of needle biopsy specimens and these patients have a 50% risk
of cancer on repeat biopsy. This is a distinct diagnostic entity based on the absolute uncertainity regarding its diagnosis. Repeat biopsy
is a must if deeper sections and immunohistochemistry are inconclusive. When an atypical small acinar proliferation (ASAP)
diagnosis represents under sampled cancer, the cancer is clinicopathologically similar to cancer diagnosed on first biopsy. Cancer
detected on the second or third round of biopsies after an atypical small acinar proliferation (ASAP) diagnosis is also similar in grade,
stage, and size to cancer detected in control patients in the first biopsy set .