title: The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy.
abstract: OBJECTIVE
  To determine the clinical significance of nondiagnostic small acini showing cellular atypia (atypical small acinar proliferation) in prostatic biopsies of patients with clinical findings suggestive of malignancy.
  
  
  METHODS
  Of 331 patients who   underwent thin-core biopsy of the prostate over a   30-month period, 21 (6.3%) had atypical   histological features, and of these 17 underwent   repeat biopsy. In addition, a further 20 patients   with normal histology underwent repeat biopsy for   persistent abnormal clinical findings. The   incidence and Gleason score of carcinomas   subsequently diagnosed in the two groups were   compared. The predictive significance of patient   age, prostate specific antigen (PSA) level and   digital rectal examination (DRE) findings were   compared between both patient groups, those in   each group subsequently found to have carcinoma,   and between patients with malignant or normal   repeat biopsies who had either atypical or normal   initial biopsies.
  
  
  RESULTS
  Nine patients with atypical histology and   four with normal histology on initial biopsy were   found to have carcinoma on subsequent biopsy   (P = 0.036). The site of carcinoma diagnosed in   the repeat biopsy frequently differed from that of   the initial atypical biopsy. The Gleason primary   pattern was not significantly different between the   groups. Neither patient age, PSA level nor DRE   findings differed between patients with initial   normal or atypical biopsy, or in these groups for   those in whom carcinoma was subsequently   diagnosed. These clinical features did not   distinguish between those with carcinoma or   normal findings on repeat biopsy who had an   initial atypical biopsy, while only PSA level   varied significantly in patients with normal or   malignant repeat biopsy in the group with an   initial normal biopsy.
  
  
  CONCLUSIONS
  The presence of atypia on initial   biopsy is a strong predictor of malignancy in   subsequent biopsy specimens.
authors.affiliation: Department of Surgery, Wellington School of Medicine, University of Otago, New Zealand.
authors.forename: R C
authors.initials: RC
authors.lastname: Ouyang
authors.forename: D N
authors.initials: DN
authors.lastname: Kenwright
authors.forename: J N
authors.initials: JN
authors.lastname: Nacey
authors.forename: B
authors.initials: B
authors.lastname: Delahunt
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D002455:Cell Division; D006801:Humans; D008297:Male; D010808:Physical Examination; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen