For any individual, the thought of undergoing a biopsy can be unnerving. For men, the prospect of a prostate needle biopsy helping to detect prostate cancer can be particularly anxiety-inducing, given the procedure’s sensitive nature. The results add to this apprehension, which can sometimes return as “atypical.” Understanding what this means and the steps that follow is crucial for navigating this challenging situation.
What is a Prostate Needle Biopsy?
A prostate needle biopsy is typically recommended when a man’s prostate-specific antigen (PSA) levels are elevated, suggesting the man’s further investigation. A urologist performs the procedure by collecting tissue samples from the prostate using a thin needle. This is most commonly done via a transrectal approach but can also be performed through the urethra (transurethral) or the perineal region (between the scrotum and anus).While effective, the procedure carries potential risks such as pain, bleeding, and infection. To minimize discomfort, doctors often use sedation, a prostatic block anesthetic, and antibiotics.
Interpreting the Pathology Report
Once the biopsy is complete, a pathologist sends the collected samples to a laboratory for microscopic examination. The pathologist’s report provides a detailed analysis, indicating whether the specimen is cancerous or something in between.In about 5% of prostate biopsies, the report may describe findings as:
Atypical small acinar proliferation (ASAP)
Suspicious for cancer
Glandular atypia
These terms are used interchangeably to indicate that the pathologist cannot definitively diagnose cancer when the cells do not appear completely normal. The findings suggest a possible presence of cancer, but the evidence is inconclusive.
Why is Cancer Detection So Challenging?
Examining prostate cells under a microscope can be complex. Specific cellular changes may resemble cancer but lack definitive characteristics. Because biopsy samples are small, subtle cancerous cells can sometimes be missed. Pathologists take great care to avoid misdiagnosing cancer, especially when findings are ambiguous.
What Happens After an “Atypical” Result?
Receiving a report with atypical findings often means that these men will likely be advised by their urologist to have a repeat biopsy within 4 to 6 months. While undergoing another biopsy may be unappealing, it ensures that any missed cancerous cells are identified early.However, every case is unique, and there may be situations where a repeat biopsy is only sometimes necessary. Open communication with your urologist is essential to determine the best course of action for your circumstances.
Additional Findings in a Biopsy Report
In addition to atypical findings, a pathology report might include other terms that can be confusing. Here are a few commonly encountered ones:
High-grade PIN can sometimes precede prostate cancer, but when atypical cells are present, these findings are less significant.
Acute or Chronic Inflammation:
These terms indicate prostatitis, which can elevate PSA levels but is unrelated to cancer.
Atrophy or Atypical Adenomatous Hyperplasia:
These findings describe cellular changes that may resemble cancer but are ultimately benign.
The Importance of Informed Discussions
If you receive an atypical biopsy result, take the time to discuss your options thoroughly with your urologist. Understanding the implications of your pathology report and the potential next steps can help you feel more prepared and less overwhelmed.Knowledge is a powerful tool for managing your health. You can work closely with your healthcare team to achieve the best possible outcomes by staying informed and proactive.Dr. David Samadiis the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer Now What? A Practical Guide to Diagnosis, Treatment, and Recovery and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.
