Two Sequential Diagnoses of Atypical Foci Suspicious for Carcinoma on Prostate Biopsy: A Follow-up Study of 179 Cases

Objective To follow-up the outcomes with patients who have had 2 consecutive “atypical foci suspicious for carcinoma (ATYP)” diagnoses from prostate biopsies. Materials and Methods A total of 516 men who had prostate core biopsy specimens with 2 sequential diagnoses of ATYP from 2003 to 2012 from 1 institution were studied. Results Of the 516 men, 179 underwent additional repeat biopsy (34.8%) after 2 ATYP diagnoses. No difference was found between the patients with and without a repeat biopsy after 2 ATYPs in terms of patient age, serum prostate-specific antigen levels, and digital rectal examination and transrectal ultrasound findings. On repeat biopsy after 2 ATYP findings, 95 of the 179 men (53.1%) had benign prostatic tissue or high-grade prostatic intraepithelial neoplasia, 65 (36.3%) had cancer, and 19 (10.6%) had a third finding of ATYP. The Gleason score in the cancer group was 3+3=6 (50 patients, 77%), 3+4=7 (12 patients, 18.5%), 4+3=7 (1 patient, 1.5%), and 4+4=8 (2 patients, 3%). No difference was seen between those without (benign, high-grade prostatic intraepithelial neoplasia, or ATYP) and with cancer in terms of patient age, serum prostate-specific antigen level, digital rectal examination and transrectal ultrasound findings, and interval between the 2 ATYP biopsies and the interval between the first ATYP and last biopsy. Conclusion The results of our study have shown that 36.3% men will be diagnosed with cancer on biopsy after 2 ATYP diagnoses, with 23% having a Gleason score of ≥7. Because no clinical features were predictive of which patients would have cancer on the follow-up biopsy, close follow-up and repeat biopsy are warranted.