Significance of focal proliferative atrophy lesions in prostate biopsy cores that test negative for prostate carcinoma

Asimakopoulos, Anastasios D.; Miano, Roberto; Mauriello, Alessandro; Costantini, Sara; Pasqualetti, Patrizio; Liberati, Emanuele; Agrò, Enrico Finazzi; Germani, Stefano; Virgili, Guido; Vespasiani, Giuseppe

doi:10.1016/j.urolonc.2010.01.010

« Previous Next »Urologic Oncology: Seminars and Original Investigations
Volume 29, Issue 6 , Pages 690-697, November 2011

Significance of focal proliferative atrophy lesions in prostate biopsy cores that test negative for prostate carcinoma

Anastasios D. Asimakopoulos, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
- These authors contributed equally to this work.
- Corresponding author. Tel.: +39-06-20902835; fax: +39-06-20902975
Roberto Miano, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
- These authors contributed equally to this work.
Alessandro Mauriello, M.D.
- Institute of Pathology, University of Rome Tor Vergata, Rome, Italy
Sara Costantini, M.D.
- Institute of Pathology, University of Rome Tor Vergata, Rome, Italy
Patrizio Pasqualetti
- Medical Statistics and Information Technology, Fatebenefratelli Association for the Research, Isola Tiberina, Rome, Italy
- Casa di Cura San Raffaele Cassino e Irccs San Raffaele Pisana, Rome, Italy
Emanuele Liberati, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
Enrico Finazzi Agrò, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
Stefano Germani, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
Guido Virgili, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
Giuseppe Vespasiani, M.D.
- Division of Urology, Department of Surgery, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy

Received 4 September 2009; received in revised form 27 January 2010; accepted 28 January 2010. published online 10 May 2010.

Abstract

Objectives

To evaluate the prevalence and short-term follow-up of focal proliferative atrophy lesions, either with or without the presence of inflammation (PIA/PA), and its correlation with the PSA levels, focusing on the prostate biopsy cores that test negative for prostate adenocarcinoma (PCa).

Methods

Five hundred fifty consecutive patients who had undergone a transrectal ultrasound-guided transperineal prostate biopsy were evaluated retrospectively for the presence and follow-up of focal proliferative atrophy lesions. PIA/PA were defined according to De Marzo. The prevalence of atrophy in PCa and negative biopsy cores was compared by means of χ². After logarithmic transformations of the PSA values, t-test and ANOVA were applied for the comparison of the means. Incidence of newly diagnosed PCa during follow-up (mean 33.7 months) in patients with or without focal proliferative atrophy was compared by means of χ².

Results

A focal atrophic lesion resulted in 161/339 negative biopsies. PIA was observed in 93/161 patients (57.8%), while PA was observed in the remaining 68/161 (42.2%). Among the negative biopsy cases, the difference in PSA values were not statistically significant according to the presence or absence of atrophy (P = 0.120). The group of negative biopsies with PIA was similar in terms of PSA characteristics with the benign (PA P = 0.738; non-atrophy P = 0.342), and cancer subgroups (P = 0.094); 245/339 (72.3%) patients were successfully followed-up. Biopsy was repeated in 24/71 (33.8%) patients with PIA, in 14/50 (28%) with PA and in 27/124 (21.7%) with no atrophy lesions at initial biopsy. The incidence of newly diagnosed PCa in the 3 groups was not statistically different (χ², P = 0.81).

Conclusions

Focal proliferative atrophy lesions are a common finding in biopsy specimens negative for PCa. Patients with negative biopsy associated with PIA presented similar PSA characteristics as patients with biopsy-proven PCa. However, the incidence of PCa at short-term follow-up did not differ significantly between patients with PIA, PA, or no atrophic lesions at initial biopsy. Based on our findings, early repeat biopsy does not seem to be necessary after an initial diagnosis of PIA/PA, although a longer follow-up is mandatory for definitive conclusions.

Keywords: Prostate cancer, Biopsy, Atrophy, Preneoplastic lesions