When a prostate needle biopsy comes back “atypical”

Biopsies from any area of the body can always make one nervous.  The waiting and wondering of what the results will reveal can be worrisome to say the least.  For men, just the thought of having a prostate needle biopsy can be anxiety driven due to the location of the body. 

A biopsy of the prostate is done when a blood test shows a high level of prostate specific antigen (PSA).  A urologist will perform a prostate biopsy by using a thin needle inserted through the rectum (transrectal biopsy), through the urethra (transurethral), or through the area between the anus and scrotum (perineal).  A transrectal biopsy is the procedure most commonly used.

A biopsy of the prostate is not to be taken lightly as it can result in pain, bleeding, and infection.  The doctor can minimize these effects by using conscious sedation or an anesthetic called a prostatic block and by prescribing a course of antibiotics at the time of the biopsy. 

Understanding the pathology report

After the prostate is biopsied, the samples will be taken to a laboratory to be examined under a microscope by a pathologist.  The pathologist’s report will tell the doctor in charge of the patient the diagnosis in each core sample taken from the prostate – whether the samples taken are cancerous or benign and if cancer is present how aggressive it is.

Sometimes, in about 5 percent of prostate biopsies done, the report may come back with findings that say “atypical” or “atypical small acinar proliferation (ASAP),” or “suspicious for cancer” or “glandular atypia.”  What do these terms mean?

Basically the terms, which can be used interchangeably, mean the pathologist has seen something under the microscope within the cells that could be cancer but yet the pathologist is not 100% certain that cancer is present. Suspicious results mean that the cells don’t look like cancer, but they don’t look quite normal, either. 

Spotting cancer using a microscope can be difficult as there can be substances within the cells that look like cancer but yet are not.  They don’t exactly look like normal, healthy cells but also may not totally look like typical prostate cancer cells should. The pathologist will want to be very careful and cautious when diagnosing prostate cancer as the biopsy samples are usually quite small. 

Does having “atypical” cells mean I have to have a repeat biopsy?

No man wants to have a repeat of a prostate biopsy.  But if the pathology report comes back with findings of “atypical cells” most men will likely be advised by their urologist to have a second biopsy within 4 to 6 months.  Remember, the pathology report is basically saying that the features of the cells look highly suggestive but are not diagnostic for carcinoma of the prostate.  However, there is always the chance that cells indicating prostate cancer may have been missed with the first biopsy.  Keep in mind there may be situations where a repeat biopsy may not be recommended but it is important to discuss with your doctor the best course of action to take for you. 

There was other terminology besides “atypical cells” on the pathology report – what do they mean?

Sometimes the biopsy report can have other medical terminology of additional findings by the pathologist such as:

·      “High grade prostatic intraepithelial neoplasia” also known as “high grade PIN”

This finding is not relevant for someone who already has a biopsy that is “atypical” or “suspicious for cancer.”  Sometimes high grade PIN can be a precursor to prostate cancer but the atypical findings are more of a concern for the risk of cancer.

·      “Acute inflammation” or “chronic inflammation”

Either term can mean acute prostatitis or chronic prostatitis.  Both can increase the results of the PSA blood test but for most men it will not indicate prostate cancer.

·      “Atropy” or “atypical adenomatous hyperplasia”

Again, these are terms of things the pathologist sees when looking through the microscope that may look like cancer but will not be found to be prostate cancer when seen on the biopsy.

Any man receiving an “atypical prostate needle biopsy,” should always have a thorough discussion with their urologist regarding the procedure and what happens afterwards. The better informed and prepared a man is regarding this situation, the greater likelihood of a good outcome.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.