The rate of clinically significant prostate cancer on repeat biopsy after a diagnosis of atypical small acinar proliferation: A systematic review and meta-analysis.

INTRODUCTION: Atypical small acinar proliferation (ASAP) is detected in approximately 5% of prostate biopsies. Current guidelines recommend a repeat biopsy within 3-6 months after the initial diagnosis. However, clinical significance and outcomes of repeat biopsy are conflicting. Based on this situation, we conducted a meta-analysis to report the rate of clinically significant prostate cancer (csPCa) on repeat biopsy after a diagnosis of atypical small acinar proliferation (ASAP) to determine the safety and validity of deferring repeat biopsy. METHODS: We searched PubMed, Medline, Web of Science, and Embase databases for articles published until July 2023. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias for the included studies. Pooled ratios and 95% confidence intervals (CIs) were calculated using Stata 17. RESULTS: Sixteen studies and 1,796 patients were included in the meta-analysis. A total of 553 patients were diagnosed with prostate cancer, and 204 had csPCa. The pooled rate of csPCa on repeat biopsy after ASAP diagnosis was 12.1% (95%CI: 0.09, 0.15), which is a relatively low progression rate. However, we observed heterogeneity among the 16 articles. Subgroup analysis was performed, and patients who underwent repeat biopsy within 6 months according to the guidelines had a lower csPCa incidence (effective size (ES)=0.09, 95%CI: 0.060, 0.120) than those who underwent biopsy after more than 6 months (ES=0.221, 95%CI: 0.094, 0.349). CONCLUSION: Repeat biopsy can be safely deferred for patients diagnosed with ASAP. We believe our results may help to improve management strategies and encourage clinicians to choose more patient-friendly or non-invasive diagnostic evaluations.

Detection of Plasma Antibodies Against CD25-Derived Peptide Antigens in Bladder Cancer.

BACKGROUND: Altered anti-CD25 antibody levels in plasma have been observed in patients with various solid malignancies. The present study aimed to determine whether circulating anti-CD25 antibody levels were altered in bladder cancer (BC). METHODS: An enzyme-linked immunosorbent assay was developed in-house to detect plasma IgG antibodies against three CD25-derived linear peptide antigens in 132 patients with BC and 120 control subjects. RESULTS: The Mann-Whitney U-test indicated that the plasma levels of anti-CD25a (Z = -10.11, p < 0.001), anti-CD25b (Z = -12.79, p < 0.001), and anti-CD25c IgG (Z = -11.95, p < 0.001) were significantly lower in BC patients than in the control group. Further analysis indicated that the plasma levels of anti-CD25a IgG antibody were stage-dependent and associated with different postoperative histological grades (U = 977.5, p = 0.003). The receiver operating characteristic curve analysis showed that the area under the ROC curve (AUC) was 0.869 for anti-CD25a IgG (95%, 0.825 - 0.913), 0.967 for anti-CD25b IgG (95%, 0.945 - 0.988), and 0.936 for anti-CD25c IgG (95%, 0.905 - 0.967), with a sensitivity of 91.3% for the anti-CD25a IgG assay, 98.8% for the anti-CD25b IgG assay, and 96.7% for the anti-CD25c IgG assay, against a specificity of 95%. CONCLUSIONS: The present study suggests that circulating anti-CD25 IgG may have a potential predictive value for clinical staging and histological grading of BC.

[A single center study：An analysis of the safety and validity of delaying repeated biopsy for patients with atypical small acinar proliferation].

OBJECTIVE: To explore the association between atypical small acinar proliferation (ASAP) and subsequent diagnosis of intermediate and high risk prostate cancer (PCa), and analyze whether delaying repeat biopsy timing is safe and effective. METHODS: From June 2000 to June 2022, we retrospectively analyzed the clinical data of 276 patients accepting prostatic biopsy and diagnosed with ASAP in China-Japan Union Hospital of Jilin University. 54.7% (151/276) patients had a repeat biopsy. We used statistic methods to process the data. RESULTS: 25.2%（38/151）patients were diagnosed with PCa on repeat biopsy. Among them, 78.9%（30/38）patients had Gleason score (GS) 3+3 and 21.1% (8/38) had GS 3+4 disease. There were 4 and 6 patients got RP respectively in the two cohorts. Only 5.3% (8/151) of ASAP patients were diagnosed as intermediate risk PCa in repeated biopsy and specially, no high risk PCa was identified in our study. CONCLUSION: It was safe and valid to delay the repeat biopsy.

Case report: Solitary fibrous tumor of the kidney with a NAB2-STAT6 fusion gene.

Background: Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that mostly originates from the pleura, and accounts for only 2% of all soft tissue tumors. Moreover, the cases of SFT of the kidney are rarely reported. Here, we report a typical case of kidney SFT, which was consistent with other reported cases. This case further expands on existing diagnostic methods of SFT and explains the importance of STAT6 mutations in SFT. Case Summary: We report a typical case of SFT of the kidney. A 34-year-old woman presented to the urinary surgery department after physical examinations were suggestive of a urologic neoplasm. Further relevant imaging investigations suggested a renal tumor with benign behaviors. The patient was diagnosed with a kidney tumor suspected to be SFT and underwent laparoscopic radical left nephrectomy. Postoperative pathological immunohistochemical tests showed positivity for Signal Transducer and Activator of Transcription 6(STAT6), CD-34, CD-99, and Bcl-2, thus confirming the diagnosis of SFT. Combined with the results of genetic testing of the patient, the tumor was indicated to carry NGFI-A-Binding protein 2(NAB2): exon 6-STAT6: exon 16 mutation sites, which confirmed our diagnosis. The patient recovered quickly without any clinical evidence of incomplete resection. She has been followed-up for more than a year and will continue to be reviewed every three months to observe the final outcomes. Conclusion: Solitary fibrous tumor is difficult to differentiate from other renal tumors. CT imaging, STAT6 immunostaining and gene profiling are valid investigations to establish the diagnosis.