A new “ASAP Scoring System and Risk Table” in patients with Atypical Small Acinar Proliferation (ASAP) to predict the second prostate biopsy outcomes

Background: To discuss the necessity of the second prostate biopsy in the patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table as a new re-biopsy criteria. Methods: 2845 patients who were performed transrectal ultrasonography-guided prostate biopsy between January 2008 and May 2019 were evaluated. 128 patients, whose data were reached, were enrolled into the study. Before the first and the second biopsy, tPSA, fPSA, f/tPSA rate and PSA-Density assessment and changes in these parameters between the two biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy. Results: The mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of the patients with PCa were statistically significantly higher than the patients with non-PCa (p: 0.001). In the ROC curve analysis of ASS-RT, area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT score in diagnosis of malignancy was ≥ 7. The sensitivity of this value was found to be 60.8% and its specificity as 80.5%. Conclusions: The threshold value for the ASS-RT score may be used as 7 and the second biopsy may be performed immediately to patients over this value. We think that there may be no need for a second biopsy if the ASS-RT score under the 7 (especially low-risk group) before the second biopsy.