Role of multi-parametric magnetic resonance (mpmr) predicting the need for prostate re-biopsy in patients with atypical small acinar proliferation (asap): a monocentric study

Abstract Introduction The European Urology guidelines recommended until 2020 to re-biopsy patients with ASAP in prostate tissue, given the high possibility of detecting cancer in a biopsy (approximately 30%), however the second rate of clinically significant prostate cancer is relatively low (reported between 5 and 20% of these biopsies). The role of mpMRI prior to re-biopsy in these patients is currently unknown. To date there are only two publications that have included patients with ASAP and re-biopsy with previous mpMRI. Methods Descriptive and retrospective study. Data were collected from 66 patients between March 2015 and May 2021, who were diagnosed with ASAP in a first prostate biopsy (either with MRI before or after it) and a second biopsy (re-biopsy) performed by image fusion. MRI- transrectal ultrasound (cognitive or software) with transrectal or transperineal sample collection. Results In 27 of 66 patients (40.9%) the biopsy was positive: in 2 cases ASAP appeared in the re-biopsy, followed by ISUP1 (clinically not significant) in 14 patients (21.21%). Only in 11 patients (16.7%) did the biopsy yield a clinically significant prostate cancer result (ISUP2 or higher). Among the 29 patients who had positive MRI (PIRADS 3 or higher), 18 cases (62%) had positive biopsies: 10 patients (34.4%) had ISUP1 while 8 (27.5%) patients had ISUP2 or higher. Conclusions Performing mpMRI before or after the biopsy in patients with ASAP can help avoid unnecessary biopsies.