<p><strong>In patients with ASAP, clinicians should perform additional testing, which may include repeat biopsy. (<em>Moderate Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>In routine pathology reports, ASAP is synonymous with a small focus (or foci) of atypical glands suspicious, but not definitive, for a diagnosis of carcinoma.<sup>269-271</sup> An ASAP finding alone on needle biopsy is associated with a 30% to 50% risk of prostate cancer detection on repeat biopsy,<sup>246, 258, 262, 266, 269-276</sup> with approximately 10% to 20% of these being GG2+.<sup>258, 274-276</sup> A recent meta-analysis reported that following a diagnosis of ASAP on initial biopsy, the pooled incidence rate of GG2+ cancer detection on repeat biopsy was 12%.<sup>277</sup> MRI guidance was rarely used for the initial biopsy for many patients in this study. Nevertheless, based on this study, the previous Expert Opinion can now be considered a Moderate Recommendation, and now includes repeat biopsy among options for repeat testing. Less information is available on the risk of prostate cancer detection following an ASAP diagnosis in patients for whom MRI-targeted biopsy was included in the initial biopsy. Given these risks, additional testing should be considered following an ASAP diagnosis, which may include repeat systematic needle biopsy with consideration of mpMRI +/- targeted biopsy, PSA, as well as urine-, serum-, or tissue-based biomarkers (<strong>see Statements 25 and 30</strong>). Evidence is limited regarding the optimal tests to use in this setting. Regarding repeat testing, including biopsy, there is limited evidence on optimal timing following an ASAP diagnosis. Patients with a diagnosis of ASAP in the setting of other biopsy cores showing invasive prostate cancer should be managed in accordance with the definitive carcinoma component.<strong> </strong></p>