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Prostate pointers—PIN, ASAP, mimics, and markers

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Karen Lusky

April 2016—Presenting on prostate cancer diagnosis at CAP ’15 last fall, David G. Bostwick, MD, MBA, recalled how he and Kenneth A. Iczkowski, MD, came up with the term “atypical small acinar proliferation suspicious for but not diagnostic of malignancy,” or ASAP, when they were at Mayo Clinic in 1997.

They had scoured the Mayo files trying to spot the right term because they didn’t know what to call it, said Dr. Bostwick, who is medical director of Granger Diagnostics in Richmond, Va. “Should we call it suspicious but not diagnostic? Should we call it worrisome? Problematic?” Dr. Bostwick joked that his favorite expression seen in the files as a prostate biopsy finding in the 1980s was “semi-malignant,” saying, “I still don’t know what that means.”

At the meeting last year and in a recent interview with CAP TODAY, Dr. Bostwick talked about ASAP, high-grade prostatic intraepithelial neoplasia, prostate adenocarcinoma, and the presumptive etiology of the malignancy.

“We think prostate cancer is almost a poster child for oxidative stress as a cause of cancer. There’s always a low-grade, chronic inflammation present,” he said.

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