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Introduction: Atypical glands suspicious but not diagnostic for malignancy (atypia) is a descriptive term found in pathology reports of prostate needle biopsies. Prior reports suggest this finding carries a 40% risk of prostate cancer on subsequent biopsies. We investigated the incidence of atypia on biopsy specimens and pathologic findings on repeat biopsy.
Methods: We retrospectively reviewed our database of prostate needle biopsies performed from November 1987 to March 2011. 10,720 patients underwent 13,595 biopsies. 567 of the 10,720 patients (5.3%) had at least one biopsy with atypia; 623 of the 13,595 biopsies (4.6%) contained atypia. Patients undergoing a repeat prostate biopsy within one year of a diagnosis of atypia were identified. Patients with a prior history of prostate cancer were excluded.
Results: 284 patients met these inclusion criteria and underwent 305 sets of prostate biopsies within one year of a diagnosis of atypia. 103 patients (36%) were found to have prostate cancer. Rates of prostate cancer, atypia, high grade prostatic intraepithelial neoplasia, and benign histology are shown in Table 1. Pathologic Results in 4 patients were unavailable.
Conclusions: Unlike high grade prostatic intraepithelial neoplasia, a significant number of men with atypia are found to have prostate cancer on repeat biopsy within one year. Immediate repeat biopsy should be recommended in this patient population.