"Remember how we used to get hung up on ASAP or HG-PIN? Nowadays we ignore these and rightly so." The NCCN and AUA guidelines do not recommend ignoring ASAP. Atypical Small Acinar Proliferation means the cells don't look completely normal, but don't look like cancer. It's like being in a "gray zone." NCCN considers ASAP an indication for repeat biopsy within 3-6 months, resampling the site of ASAP and adjacent areas. AUA acknowledges ASAP as a high-risk finding requiring follow-up with a repeat biopsy within 3-12 months. NCCN views ASAP as a finding that warrants further investigation due to the increased likelihood of finding prostate cancer on a subsequent biopsy.
You are right the guidelines say not to ignore ASAP yet I went to doctors at three different NCCN cancer centers and two said we don’t care about ASAP (the third did order another biopsy). So the Dr in the article is right, they do ignore ASAP, although they are not supposed to.
These are guidelines, which say not to ignore ASAP. Doctors at NCCN centers are free to make their own practice decisions because these guidelines are not hard and fast rules, simply guidelines.
Also, it seems that guidelines were made to be broken. And urologists are among the leaders in breaking the guidelines. There is no enforcement. They’re only guides; not laws.
HG-PIN got me into this pickle 15 years ago. Back then, they considered HG-PIN a precursor to cancer. Dr. Epstein gavethe second opinion and suggested I come back in six months.
I did. A single core of Gleason 6 was found, 1 mm.
Hi all. Interesting to see this exchange. In the current MRI era, patients found to have only ASAP or HGPIN do NOT need a repeat based on this histology. Any repeat biopsy would instead be based on an unexplained rising PSA or suspicious MRI. But if a pre-biopsy MRI isn't being done.....
The NCCN and AUA guidelines need to be updated here.
EAU guidelines do not even mention HGPIN or ASAP as factors for repeat biopsy.
"Remember how we used to get hung up on ASAP or HG-PIN? Nowadays we ignore these and rightly so." The NCCN and AUA guidelines do not recommend ignoring ASAP. Atypical Small Acinar Proliferation means the cells don't look completely normal, but don't look like cancer. It's like being in a "gray zone." NCCN considers ASAP an indication for repeat biopsy within 3-6 months, resampling the site of ASAP and adjacent areas. AUA acknowledges ASAP as a high-risk finding requiring follow-up with a repeat biopsy within 3-12 months. NCCN views ASAP as a finding that warrants further investigation due to the increased likelihood of finding prostate cancer on a subsequent biopsy.
You are right the guidelines say not to ignore ASAP yet I went to doctors at three different NCCN cancer centers and two said we don’t care about ASAP (the third did order another biopsy). So the Dr in the article is right, they do ignore ASAP, although they are not supposed to.
These are guidelines, which say not to ignore ASAP. Doctors at NCCN centers are free to make their own practice decisions because these guidelines are not hard and fast rules, simply guidelines.
Uropathology experts explains ASAP: https://howardwolinsky.substack.com/p/biopsy-guru-answers-a-prostate-pathology?utm_source=publication-search
Also, it seems that guidelines were made to be broken. And urologists are among the leaders in breaking the guidelines. There is no enforcement. They’re only guides; not laws.
https://howardwolinsky.substack.com/p/whats-in-a-guideline-maybe-less-than?utm_source=publication-search
HG-PIN got me into this pickle 15 years ago. Back then, they considered HG-PIN a precursor to cancer. Dr. Epstein gavethe second opinion and suggested I come back in six months.
I did. A single core of Gleason 6 was found, 1 mm.
The cancer was never seen again.
But I was left with the cancer diagnosis.
Hi all. Interesting to see this exchange. In the current MRI era, patients found to have only ASAP or HGPIN do NOT need a repeat based on this histology. Any repeat biopsy would instead be based on an unexplained rising PSA or suspicious MRI. But if a pre-biopsy MRI isn't being done.....
The NCCN and AUA guidelines need to be updated here.
EAU guidelines do not even mention HGPIN or ASAP as factors for repeat biopsy.
Thanks, Dr. G.
Best yet "Wow. The world is a zoo and circus."
I'd make a comment about the monkeys and the clowns, but I'd just get in trouble.
Be brave and be prepared top get into trouble.