Risk of prostate cancer after diagnosis of atypical glands suspicious for carcinoma on saturation and traditional biopsies

Purpose: Prostatic glandular atypia is present in approximately 5% of traditional template biopsy specimens. Prior reports suggest this finding carries a 40% risk of prostate cancer on subsequent biopsy. We determined the risk of malignancy in patients with atypia diagnosed on saturation biopsy. Materials and Methods: We identified 57 patients with a diagnosis of atypia who underwent repeat biopsy between January 2001 and August 2007. Charts were reviewed for clinical and pathological information. Results: Median patient age was 62 years (range 46 to 79). Of the 57 patients 19 (33%) had atypia diagnosed on saturation biopsy (20 cores or greater) (group 1), whereas 38 (67%) had atypia diagnosed with a more traditional biopsy technique (12 cc-res or fewer) (group 2). All patients subsequently underwent saturation repeat biopsy a median of 5 months after the original biopsy. Eight group 1 patients (42%) were found to have cancer on rebiopsy compared to 15 (39.5%) in group 2 (p = 1.00). Whereas only 1 of the 8 patients (12.5%) with cancer in group 1 had a Gleason score of 7 or greater, this was found in 5 of the 15 (33%) in group 2 (p = 0.37). Interestingly patients with cancer were less likely to have inflammation on initial biopsy (p = 0.05). Conclusions: The finding of atypia on prostate biopsy is associated with a high likelihood of underlying malignancy regardless of the number of cores taken on initial biopsy. Inflammation in the initial biopsy may create a false-positive finding of atypia.