Introduction
Prostate cancer (PCa) is the most diagnosed cancer, apart from skin cancer, on the men over 70 years of age1. Needle core prostate biopsy is a gold standart to diagnose of PCa. Atypical small acinar proliferation (ASAP) first defined by Bostwick et al. 2 and described as a focus of small acinar structures (<0.4 mm) formed by atypical epithelial cells in needle core prostate biopsy. ASAP is diagnosed at 5% of all prostate biopsies 3,4 and considered precancerous lesion of prostate tissues 5,6. Second prostate biopsy is routinely recommended by current National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) guidelines7,8 due to 30-40% PCa risk for the patients reported ASAP as a result of the initial biopsy9,10.
Morbidity associated with needle core prostate biopsy is a problem to both patients and clinicians 11-13. Some of the patients want to delay the second biopsy as much as possible. Furthermore, TRUS-guided prostate biopsy is high cost process14. In addition to its morbidity and high cost, it is also not associated clinically significant or high risk PCa15. Therefore, the second prostate biopsy has been controversial for many years.
In this study, we aimed to discuss the requirement of the repeat biopsy routinely for the patients with ASAP and which patients should be absolutely evaluated. We offered a scoring system and risk table that may be able to guide the decision of second prostate biopsy.