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Prostate Atypia: Repeat Biopsy Results Within One Year of Diagnosis

Cory D. Harris1, Stuart Kesler2, Joseph R. Wagner3
1University of Connecticut, Farmington, CT;2Harford Hospital, Hartford, CT;3Hartford Hospital, Hartford, CT

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.

Pathology Results on Repeat Biopsies for Atypia
Total Number of Biopsies305
Prostate cancer103 (33.8%)
Atypia56 (18.4%)
HPIN18 (5.9%)
Benign124 (40.7%)
Unknown4 (1.3%)

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