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<p>Atypical intraductal proliferation (AIP) is considered a borderline lesion, characterized by architectural complexity and cytological atypia greater than that seen in high-grade prostatic intraepithelial neoplasia, but insufficient to fulfil the diagnostic criteria for intraductal carcinoma (IDC). Consequently, AIP remains diagnostically challenging, and the clinical significance of this lesion is still uncertain. Emerging evidence suggests that AIP in prostate biopsy specimens is a strong predictor of unsampled IDC and other adverse pathological features, warranting reconsideration of the AIP role in prostate cancer risk stratification. Results from prospective and molecular studies indicate that AIP frequently coexists with intermediate-risk prostate cancer and shares molecular alterations with IDC, such as PTEN loss and ERG overexpression, reinforcing AIP potential as a marker of occult aggressive disease. Considering the growing emphasis on precision diagnostics and active surveillance in prostate cancer management, understanding the implications of AIP is particularly relevant.</p>

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Atypical intraductal proliferation in prostate biopsy — a diagnostic grey zone with clinical implications

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Rui M. Bernardino,
  • João Lobo,
  • Jihad Kaouk,
  • Theodorus van der Kwast,
  • Susan Prendeville,
  • Fabio Zattoni,
  • Lorenzo Bianchi,
  • Alberto Martini,
  • Pawel Rajwa,
  • Veeru Kasivisvanathan,
  • Giancarlo Marra,
  • Neil Fleshner,
  • Giancarlo Marra,
  • Lorenzo Bianchi,
  • Matteo Bauckneht,
  • Francesco Giganti,
  • Isabel Heidegger,
  • Veeru Kasivisvanathan,
  • Claudia Kesch,
  • Rossella Nicoletti,
  • Jonathan Olivier,
  • Felix Preisser,
  • Pawel Rajwa,
  • Lara Rodriguez-Sanchez,
  • Timo Soeterik,
  • Fabio Zattoni,
  • Francesca Ambrosini,
  • Ugo Falagario,
  • Vittorio Fasulo,
  • Tamás Fazekas,
  • Alexander Giesen,
  • Renee Hogehout,
  • Jennifer Le Guevelou,
  • Martina Maggi,
  • Chiara Mercinelli,
  • Marcin Miszczyk,
  • Ignacio Puche Sanz,
  • Marie Christine Roesch,
  • Matthijs Scheltema,
  • August Sigle,
  • Hein Stroomberg,
  • Akihiro Matsukawa,
  • Rui Bernardino

摘要

Atypical intraductal proliferation (AIP) is considered a borderline lesion, characterized by architectural complexity and cytological atypia greater than that seen in high-grade prostatic intraepithelial neoplasia, but insufficient to fulfil the diagnostic criteria for intraductal carcinoma (IDC). Consequently, AIP remains diagnostically challenging, and the clinical significance of this lesion is still uncertain. Emerging evidence suggests that AIP in prostate biopsy specimens is a strong predictor of unsampled IDC and other adverse pathological features, warranting reconsideration of the AIP role in prostate cancer risk stratification. Results from prospective and molecular studies indicate that AIP frequently coexists with intermediate-risk prostate cancer and shares molecular alterations with IDC, such as PTEN loss and ERG overexpression, reinforcing AIP potential as a marker of occult aggressive disease. Considering the growing emphasis on precision diagnostics and active surveillance in prostate cancer management, understanding the implications of AIP is particularly relevant.