Atypical Glands Suspicious for Cancer (ATYP)

  • Rajal B. ShahEmail author
  • Ming Zhou


The diagnostic term “atypical glands suspicious for cancer (ATYP),” or “atypical small acinar proliferation (ASAP),” describes a small focus of prostate glands that exhibits architectural and cytological atypia and is suspicious for, yet falls short of, the diagnostic threshold for prostate cancer. It is not a distinct biological entity; rather, it encompasses a range of lesions of varying clinical significance, including under-sampled cancer, high-grade prostatic intraepithelial neoplasia (HGPIN), benign lesions that mimic cancer, and benign prostate glands with reactive atypia. An ATYP diagnosis in prostate needle biopsy is considered a risk factor for finding prostate cancer in subsequent biopsies. Such risk ranges from 27% to 47%, with an average of 42%, in recent studies. National Comprehensive Cancer Network (NCCN) recommends patients with ATYP on initial biopsies for additional biomarker testing, such as free PSA %, prostate health index (PHI) or 4Kscore, and imaging studies, to assess the risk of high-grade cancer and consider repeated biopsy with relative increased sampling of the site of the atypical diagnosis.


Atypical glands suspicious for cancer ATYP Atypical small acinar proliferation ASAP High-grade prostatic intraepithelial neoplasia HGPIN High-molecular weight cytokeratin HMWCK PINATYP Tangential sectioning Outpouching Cancer risk associated with ATYP Repeat biopsy strategy 


  1. 1.
    Cheville JC, Reznicek MJ, Bostwick DG. The focus of “atypical glands, suspicious for malignancy” in prostatic needle biopsy specimens: incidence, histologic features, and clinical follow-up of cases diagnosed in a community practice. Am J Clin Pathol. 1997;108:633–40.CrossRefGoogle Scholar
  2. 2.
    Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol. 2018;15:55–66.CrossRefGoogle Scholar
  3. 3.
    Abouassaly R, Tan N, Moussa A, Jones JS. Risk of prostate cancer after diagnosis of atypical glands suspicious for carcinoma on saturation and traditional biopsies. J Urol. 2008;180:911–4; discussion 914.CrossRefGoogle Scholar
  4. 4.
    NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection, Version 2. 2018. Accessed 23 July 2018.
  5. 5.
    Zhou M, Magi-Galluzzi C. Clinicopathological features of prostate cancers detected after an initial diagnosis of ‘atypical glands suspicious for cancer’. Pathology. 2010;42:334–8.CrossRefGoogle Scholar
  6. 6.
    Kronz JD, Shaikh AA, Epstein JI. High-grade prostatic intraepithelial neoplasia with adjacent small atypical glands on prostate biopsy. Hum Pathol. 2001;32:389–95.CrossRefGoogle Scholar
  7. 7.
    Oliai BR, Kahane H, Epstein JI. Can basal cells be seen in adenocarcinoma of the prostate?: an immunohistochemical study using high molecular weight cytokeratin (clone 34betaE12) antibody. Am J Surg Pathol. 2002;26:1151–60.CrossRefGoogle Scholar
  8. 8.
    Iczkowski KA, Bassler TJ, Schwob VS, Bassler IC, Kunnel BS, Orozco RE, et al. Diagnosis of “suspicious for malignancy” in prostate biopsies: predictive value for cancer. Urology. 1998;51:757; discussion 757–748CrossRefGoogle Scholar
  9. 9.
    Renshaw AA, Santis WF, Richie JP. Clinicopathological characteristics of prostatic adenocarcinoma in men with atypical prostate needle biopsies. J Urol. 1998;159:2018–21; discussion 2022.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert J Tomsich Pathology and Laboratory Medicine InstituteCleveland ClinicClevelandUSA
  2. 2.Tufts Medical CenterBostonUSA

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