Ten-year follow-up of atypical small acinar hyperplasia cases diagnosed by initial prostate biopsy.

Objective: To investigate the clinical outcomes and diagnostic strategies for patients with atypical small acinar hyperplasia (ASAP) in their initial prostate biopsy in a real-world setting.

Methods: A retrospective analysis was conducted on the data of 170 patients who received their first prostate biopsy result as ASAP. The lost follow-up rate, clinical interventions, subsequent pathological results, prostate cancer detection rate, and Gleason scores were analyzed. Furthermore, subgroup analysis was performed on cases with repeat biopsies.

Results: Of the 170 patients, 45 were lost to follow-up, with a dropout rate of 26.5%. Among the remaining 125 patients, 68 did not receive clinical intervention. Meanwhile, 57 underwent clinical interventions during follow-up, including 50 with repeat biopsies (50 second-time biopsies, 8 third-time biopsies, and 2 fourth-time biopsies), 3 underwent transurethral resection of prostate (TURP), and 4 had radical surgeries. In total, 28 were diagnosed with prostate cancer, diagnoses included 22 cases from prostate biopsies, 2 from TURP, and 4 from radical surgeries. Of the 22 biopsy-confirmed prostate cancer cases, 17 underwent radical surgeries at our hospital. Postoperative pathology revealed that 71.4%(5/7) of the cases upgraded from clinically insignificant cancer to clinically significant cancer. Ultimately, clinically significant prostate cancer accounted for 85.7%(24/28) of all positive cases and 42.1%(24/57) of the clinically intervened cases. Further subgroup analysis revealed that biopsy groups 6-12 months post-initial ASAP diagnosis had a noticeably higher positive rate than those biopsied within 6 months.

Conclusion: For the patients with ASAP diagnosed by the initial biopsy, the risk of subsequent diagnosis of clinically significant prostate cancer is high. Combined with the high dropout rate and postoperative pathological escalation rate in this study cohort, it is recommended that patients with ASAP be given high priority in clinical practice, and repeated biopsy is recommended to be carried out within 6-12 months.