Atypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review

doi:10.1016/j.urology.2017.04.021

Urology

Volume 107, September 2017, Pages 5-10

https://doi.org/10.1016/j.urology.2017.04.021 Get rights and content

Multiparametric magnetic resonance imaging (mpMRI) has added to the armamentarium for the diagnosis and surveillance for organ-confined prostate cancer. Atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia (HGPIN) are premalignant prostatic lesions. The management of such lesions remains contentious, and the addition of mpMRI introduces further uncertainty, given its ability to pick up indolent lesions and its use in targeted biopsy. We aimed to perform a comprehensive review of current evidence regarding atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, and mpMRI to ascertain a consensus for a current management algorithm.

Section snippets

Methods and Results

A comprehensive review was performed in-line with the PRISMA recommendations.² MEDLINE, Web of Science, and Google Scholar databases were searched using the keywords (“acinar small atypical proliferation” OR “ASAP”) or (“high-grade prostatic intraepithelial neoplasia” or “HGPIN”) and (“multiparametric magnetic resonance imaging” or “mpMRI” or “MRI”). Articles pertaining to the management of ASAP and HGPIN were included for assessment. Literature search was performed by 2 investigators (TM, EC),

Conclusion

Contemporary evidence regarding the etiology, natural history, surveillance, and management of ASAP and HGPIN is limited. The addition of powerful imaging adjuncts, including mpMRI, introduces further uncertainty. Despite this, the addition of this new technology has shown some promise for patients and potentially has a future role as a noninvasive tool for both diagnosing and monitoring progression of premalignant disease. However, because of the paucity of literature regarding mpMRI and these

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Citation Excerpt :
Currently, many clinical guidelines recommend reporting ASAP, mHGPIN and PINATYP, due to the increased risk of future PCa [1]. However, since the recommendation of mpMRI previous to repeat prostate biopsy and the application of targeted biopsies have become widespread, little evidence exists regarding the predictive value of these NMLs [6]. Nowadays, the challenge of the PCa early detection is to detect the maximal number csPCa while reducing to the minimum the rate of unnecessary prostate biopsies and overdetection of insignificant tumours [1–5].
To assess the current ability of atypical small acinar proliferation (ASAP), multifocal high-grade prostatic intraepithelial neoplasia (mHGPIN), HGPIN with atypia (PINATYP) and other non-malignant lesions to predict clinically significant prostate cancer (csPCa) in repeat prostate biopsies.
This retrospective study analyzed 377 repeat prostate biopsies, carried out between 2.014 and 2.017, and excluding those with previous PCa or 5-alpha reductase inhibitors treatment. ASAP, mHGPIN, PINATYP, prostatic atrophy, prostatic hyperplastic atrophy, proliferative inflammatory atrophy (PIA), chronic prostatitis, acute prostatitis, or granulomatous prostatitis, were prospectively reported after 12-core transrectal ultrasound (TRUS) systematic negative previous biopsies. 3T-multiparametric magnetic resonance imaging (mpMRI) was performed previous repeat biopsies. At least 2-core TRUS targeted biopsies of Prostate Imaging-Reporting and Data Systemv2 lesions ≥3, and/or 12-core TRUS systematic biopsy were performed in repeat prostate biopsies. The main outcome measurements were csPCa detection, which was defined when the International Society of Uro-Pathology group grade >1 and avoided biopsies. After logistic regression analysis the most efficient model was selected, nomogram was designed with internal validation, and clinical utility was analyzed.
Normal benign tissue alone was present in less than 2% of previous negative biopsies. mHGPIN (39.7%), ASAP (4.3%) and PINATYP (3.7%) failed to predict csPCa risk in repeat biopsies. The finding of PIA (38.2%) associated with a decreased the risk of csPCa with an Odd ratio of 0.54 (95% confidence interval: 0.31–0.95), P= 0.031. The area under the curve, to predict csPCa, of mpMRI was 0.736, increasing up to 0.860 (95% confidence internal:0.82–0.90) when PSA density, age, digital rectal examination, and differential PSA between biopsies and PIA finding were integrated in a predictive model. At 6% threshold, more than 20% of repeat prostate biopsies were saved without missing csPCa.
Currently, mHGPIN in negative prostate biopsy seems not able to predict the risk of future csPCa. The low incidence of ASAP and PINATYP, in our series, did not allow us to draw conclusions. PIA finding associated with a reduced risk of csPCa, and it could be integrated in a useful based-mpMRI predictive nomogram.
A single centre service evaluation of the pre-biopsy mpMRI pathway for prostate cancer diagnosis
2023, Journal of Clinical Urology
The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia
2022, BJU International
The fgf/fgfr system in the physiopathology of the prostate gland
2021, Physiological Reviews
Role of apparent diffusion coefficient values in prostate diseases characterization on diffusion-weighted magnetic resonance imaging
2019, Minerva Urologica e Nefrologica

: Financial Disclosure: The authors declare that they have no relevant financial interests.

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Review ArticleAtypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review

Section snippets

Methods and Results

Conclusion

Pathol Res Pract

J Urol

J Urol

Eur Urol

Urology

J Urol

Urology

Hum Pathol

J Urol

Urology

J Urol

Eur Urol

J Urol

J Urol

Semin Roentgenol

J Urol

Urol Oncol

Eur Urol

Cancer statistics, 2016

CA Cancer J Clin

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

BMJ

High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: Is repeat biopsy still necessary?

BJU Int

Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation

Can Urol Assoc J

What's new in prostate cancer disease assessment in 2006?

Curr Opin Urol

Recommendations for the reporting of prostate carcinoma

Hum Pathol

Management of men with previous negative prostate biopsy

Curr Opin Urol

Review Article
Atypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review