Absence Of ASAP In Cystoprostatectomy Specimens

Sarah Coleman Flurry¹, Stacy Mills*², Dan Theodorescu^1
1UVA Department of Urology, Charlottesville, VA;²UVA Department of Pathology, Charlottesville, VA

Introduction: Atypical Small Acinar Proliferation (ASAP) is thought to be a precursor of prostatic adenocarcinoma when reported on prostate biopsy and the pathologic finding often leads to re-biopsy. If ASAP is pathologically a precursor to cancer, we would expect to find ASAP in cystoprostatectomy specimens for bladder cancer when adenocarcimona of the prostate is found incidentally.
Methods: A retrospective review was performed on 195 men undergoing cystoprostatectomy for bladder cancer from June 1990-March 2004. None of the men had undergone previous biopsy for elevated PSA or DRE suggestive of prostate cancer. From the pathology reports we recorded the presence of ASAP as well as the presence of prostatic adenocarcinoma.
Results: Complete data was available for all men. Adenocarcinoma was found incidentally in 59 prostates removed en bloc for bladder cancer. 24 adenocarcinomas were Gleason grade < 5 and 35 were Gleason grade >5. ASAP was not reported in any of the total prostatectomy specimens.
Conclusions: The total absence of ASAP on prostates removed en bloc as a part of cystoprostatectomy suggests that perhaps ASAP is not a precursor to prostatic adenocarcinoma but is instead an artifact of prostate biopsy and represents the biopsied edge of prostatic adenocarcinoma.

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