Prostatectomy of Simultaneous ASAP and PCa PCa [6-8]. In addition, contemporary prostate biopsy proto- cols have increased the number of cores from sextant biopsy to extended biopsy [9]. A recent report suggested that these advances have reduced the predictive value of ASAP for subsequent cancer to 37% [10]. By contrast, a report of im- mediate prostatectomies after isolated ASAP was diag- nosed described a 100% predictive value of ASAP [11]. There are many differences in the pathological entities and clinical significance of ASAP between studies. 　We reviewed radical prostatectomy (RP) specimens in patients with synchronous ASAP with PCa on prostate needle biopsy to evaluate the pathological entities and, by extension, the clinical significance of ASAP. MATERIALS AND METHODS From January 2007 to December 2008, we conducted sys- tematic transrectal ultrasound (TRUS)-guided prostate needle biopsies at our institution because of increased se- rum PSA values or abnormality on a digital rectal examina- tion (DRE). Prostate biopsies were acquired under TRUS (IU-22; PHILIPS, USA) guidance by using a biopsy gun (ACECUT; TSK Laboratory, Japan) with an 18 gauge nee- dle by one radiologist. We performed 6-core biopsies [12] in patients with a TRUS volume of less than 30 cc and 12-core biopsies [13] in patients with a TRUS volume of 30 cc or more. All specimens were stained with H&E to eval- uate features considered specific for carcinoma. In addi- TABLE 1. Patient characteristics Age (years) PSA (ng/ml) %fPSA (%) Prostate volume (cc) PSAD (ng/ml/cc) Gleason score Tumor stage Mean (range) (n=46) 69.63 (57-78) 8.17 (1.75-26.89) 14.81 (5.4-30.3) 34.40 (19.10-95.40) 0.26 (0.45-0.56) 6.65 (5-9) pT2c-pT3a (pT2a-pT3c) PSA: prostate-specific antigen, %fPSA: % free PSA, PSAD: PSA density TABLE 2. Patient characteristics after radical prostatectomy Age (years) PSA (ng/ml) %fPSA (%) Prostate volume (cc) PSAD (ng/ml/cc) Tumor stage Cancer (n=36) Mean (range) 69.64 (60-78) 8.44 (1.75-26.89) 14.49 (5.4-30.3) 32.86 (19.90-95.40) 0.27 (0.05-0.55) pT2c-pT3a (pT2a-pT3c) 399 tion, immunohistochemical stains such as 34βE12, p63, and AMACR/P504S were used for the differential diag- nosis of ASAP and carcinoma. All tissues were evaluated by one pathologist. 　A total of 118 patients underwent RP because they were diagnosed with PCa on the prostate needle biopsy at our institution. Forty-six of the 118 patients (39%) were diag- nosed as having synchronous ASAP with PCa on the pros- tate needle biopsy. In those 46 patients, the mean age was 69.63 years (range, 57-78 years), the mean PSA level before the prostate biopsy was 8.17 ng/ml (range, 1.75-26.89 ng/ml), and the mean prostate volume was 34.40 cc (range, 19.10-95.40 cc). The RP pathology results (Table 1) showed that the patients had a mean Gleason score of 6.65 (range, 5-9) and a mean pathological stage of pT2c-pT3a (range, pT2a-pT3c). 　All specimens acquired from RP were mapped by using complete sampling with whole-mount sections [14]. Using prostate mapping, we retrospectively evaluated the sites in the RP specimens that had been diagnosed as ASAP on prostate needle biopsy. All RP specimens were examined with the same H&E stain and immunohistochemical stains by one pathologist who had previously evaluated the pro- state needle biopsies. For measurement of tumor volume, visual inspection and grid morphometric analysis were done (tumor volume=1.25 x mean percentage carcinoma x number of block). 　Student’s t-test was used to assess the clinical values. Statistical analysis was performed by using statistical soft- ware (SPSS 10.1; SPSS Inc., USA), and a p-value of less than 0.05 was considered to indicate a statistically sig- nificant difference. RESULTS Thirty-six of the 46 patients (78%) who underwent RP were shown to have adenocarcinoma at the sites diagnosed as ASAP on the initial prostate needle biopsy. The character- istics of these 36 patients and those of the other 10 patients who were not diagnosed are shown in Table 2. Only patho- logical stage was statistically significantly different be- tween the groups (p＜0.005). 　Of the 36 patients, pathological stage was T2a in 4 pa- No cancer (n=10) Mean (range) 69.60 (59-76) 7.20 (3.61-20.96) 16.10 (8.7-24.0) 38.87 (19.10-65.09) 0.24 (0.03-0.56) pT2a-pT2b (pT2a-pT3a) p-valuea 0.986 0.496 0.641 0.436 0.691 ＜0.005 Korean J Urol 2010;51:398-402 PSA: prostate-specific antigen, %fPSA: % free PSA, PSAD: PSA density, Cancer: patients were revealed as PCa at the sites diagnosed as ASAP on initial prostate needle biopsy, No cancer: patients were not revealed as PCa at the sites diagnosed as ASAP on initial prostate needle biopsy, a: Student’s t-test