1. Prostate Cancer Detection in Men with an Initial Diagnosis of Atypical small Acinar Proliferations Dr Charles Chabert The Wollongong Hospital

2. Definition ASAP denotes the presence of suspicious glands with insufficient cytological or architectural atypia for a definitive cancer diagnosis Bostwick et al Hum Path.1993; 24:819

4. Objective Determine the clinical significance of ASAP in prostate biopsies

5. Methods Illawarra prostate pathology data base reviewed Jan 1994- Jan 2004 ASAP Pathology reviewed Clinical records obtained

6. Method Study cohort 31 Median age: 65 years (53-78 years) Median PSA: 7.6ng/ml (0.3-36ng/ml)

7. Results ASAP 31 9 No further Biopsy 22 Second Biopsy

8. Results of No Repeat Biopsy 9 No repeat biopsy TURP: 1 Benign Median F/U: 8 78 months 1 CAP

9. Results ASAP 31 9 No further Biopsy 22 Second Biopsy

10. Results of 2nd Biopsy Benign 4 ASAP 5 Prostate cancer 13 ASAP22/31 Median interval between 1 st & 2 nd biopsy 8 Months

11. Prostate Ca in 2 nd Biopsy 13/22 Prostate Cancer 3+3=6 (2) 3+4=7(5) 4+3=7(2) 4+4=8(3) 4+5=9(1)

12. Results of 2nd Biopsy Benign 4 ASAP 5 Prostate cancer 13 ASAP22/31

13. Results of 3rd Biopsy ASAP5 All Biopsied Prostate Ca 2 ASAP 1 Benign 2 Median interval between 2 nd & 3 rd 14 months

14. Results of 2nd Biopsy Benign 4 ASAP 5 Prostate cancer 13 ASAP22/31

15. Benign: 4 Results of 3 rd Biopsy Benign 2 ASAP 1 CAP 4+3=7

16. Summary Subsequent CAP detection 17/31 54.8 % ASAP diagnosis mandates rebiopsy

17. Acknowledgement Dr Sabar Napaki, Southern Pathology, Wollongong

18. High Grade PIN ASAP