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Q. Prostate biopsy shows reactive and atrophic acini. Is that a precursor of prostate cancer?

Answered by
Dr. Vandana Andrews
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 27, 2020 and last reviewed on: Feb 29, 2020

Hello doctor,

Prostate biopsy was prompted by rising PSA over several years (20%-25% per year) reaching over 4 this past year (spiked at 7.3 which I think really is why they wanted the biopsy but I expect it to come down since then). 12 core came back benign, but I do not understand the implications for some of the additional descriptive language and why I need continued six months follow-up.

DRE had nodules and TRUS shows calcification and volume of 27cc. Path description says reactive and atrophic acini and focally reactive. Does that mean BPH or prostatitis, or is that a precursor to PCa? I have no symptoms of BPH or prostatitis, other than getting up between 3 AM and 4 AM every morning. I think it is just an age factor. I am not interested in the DREs and TRUS procedures if it is not going to tell anything new, and I can have bloodwork done without the time and expense of a doctor's visit.

Dr. Vandana Andrews

Internal Medicine


Welcome to

I have studied your reports and consulted with my pathologist. (attachment removed to protect patient identity).

As per her advice and mine too, your reports are normal, the biopsy changes are age related. In the biopsy no carcinoma is identified. Doing DRE (digital rectal exam) and TRUS (transrectal ultrasound) again will not be beneficial as biopsy has already been done. And results are negative for cancer and BPH (benign prostatic hyperplasia).

Biopsy was done because in benign prostatic hypertrophy and prostate cancer calcification occurs in 10% of cases. And your biopsy is normal. Biopsy is the choice of diagnosis. And your biopsy is normal.

Your doctor has asked for the followup to see the changes in prostate calcification. Yes, TRUS and DRE will only show if the calcification and volume are increased or decreased, nothing else. Rest you can discuss with your physician for diagnosis and management.

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