title: Significance of atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in prostate biopsy.
abstract: OBJECTIVE
  In clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases.
  
  
  METHODS
  One hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded.
  
  
  RESULTS
  Of the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy.
  
  
  CONCLUSIONS
  The diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.
authors.affiliation: Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Koca
authors.forename: Selahattin
authors.initials: S
authors.lastname: Calışkan
authors.forename: Metin İshak
authors.initials: Mİ
authors.lastname: Oztürk
authors.forename: Mustafa
authors.initials: M
authors.lastname: Güneş
authors.forename: M Ihsan
authors.initials: MI
authors.lastname: Karaman