This study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.

Material and methods:
The study reviewed the data of 2,845 patients; who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-Density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy.

The mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer (p: 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificity

The cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is <7, especially for low-risk patients.