Advertisement

Current Issues in Pathologic Evaluation

  • Howard S. Levin
Chapter
  • 142 Downloads
Part of the Current Clinical Urology book series (CCU)

Abstract

In the past two decades there has been considerable progress in understanding the genetics and biology of prostate cancer. The pathologic diagnosis of prostatic adenocarcinoma (PCA), however, is the keystone on which its further management is presently based. Although serum prostate-specific antigen (PSA) elevation often initiates the search for PCA, PSA, the ratio of free to total serum PSA, PSA density, and PSA velocity help to define the risk of PCA but are not diagnostic at any level. The diagnosis of PCA demands pathologic confirmation. In cases of PCA subjected to radical prostatectomy (RP), the pathologic evaluation of specimens determines prognosis and further therapy to a substantial degree. A number of issues demand consideration in optimizing diagnosis, prognosis, and future therapy.

Keywords

Gleason Score Bladder Neck Androgen Deprivation Therapy Prostatic Intraepithelial Neoplasia Extracapsular Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Murphy WM. A better nuclear fixative for diagnostic bladder and prostate biopsies. J Urol Pathol 1993; 1: 79–87.Google Scholar
  2. 2.
    Kao J, Upton M, Zhand P, Rosen S. Individual prostate biopsy core embedding facilitates maximal tissue representation. J Urol 2002; 168: 496–499.PubMedCrossRefGoogle Scholar
  3. 3.
    Signoretti S, Waltregny D, Dilks J, et al. p63 is a prostate basal cell marker and is required for prostate development. Am J Pathol 2000; 157: 1769–1775.PubMedCrossRefGoogle Scholar
  4. 4.
    Zhou M, Shah R, Shen R, Rubin MA. Basal cell cocktail (34ßE12 + p63) improves the detection of prostate basal cells. Am J Surg Pathol 2003; 27: 365–371.PubMedCrossRefGoogle Scholar
  5. 5.
    Beach R, Gown AM, dePeralta-Venturina MN, et al. P504S immunohistochemical detection in 405 prostate specimens including 376 18-gauge needle biopsies. Am J Surg Pathol 2002; 26: 1588–1596.PubMedCrossRefGoogle Scholar
  6. 6.
    Zhou M, Chinnaiyan AM, Kleer CG, Lucas PC, Rubin MA. Alpha-methylacyl-CoA racemase. A novel tumor marker over-expressed in several human cancers and their precursor lesions. Am J Surg Pathol 2002; 26 (7): 926–931.PubMedCrossRefGoogle Scholar
  7. 7.
    Renshaw AA, Schultz D, Cote K, et al. Accurate grading of prostatic adenocarcinoma in prostate needle biopsies by general pathologists. Arch Pathol Lab Med 2003; 127: 1007–1008.PubMedGoogle Scholar
  8. 8.
    Humphrey PA, Walther PJ, Currin SM, Vollmer RT. Histologic grade, DNA ploidy and intraglandular tumor extent as indicators of tumor progression of clinical stage B prostatic carcinoma. A direct comparison. Am J Surg Pathol 1991; 15: 1165–1170.PubMedCrossRefGoogle Scholar
  9. 9.
    Carter HB, Sauvageot J, Walsh PC, Epstein JI. Prospective evaluation of men with T1c adenocarcinoma of the prostate. J Urol 1997; 157: 2206–2209.PubMedCrossRefGoogle Scholar
  10. 10.
    Wills ML, Sauvageot J, Partin AW, Gurganus R, Epstein JI. Ability of sextant biopsies to predict prostatectomy stage. Urology 1998; 51: 759–764.PubMedCrossRefGoogle Scholar
  11. 11.
    Bastacky SI, Walsh PC, Epstein JI. Relationship between perineural tumor invasion on needle biopsy and radical prostatectomy capsular penetration in clinical stage B adenocarcinoma of the prostate. Am J Surg Pathol 1993; 17: 336–341.PubMedCrossRefGoogle Scholar
  12. 12.
    Ro JY, Tetu B, Ayala AG, Ordonez NG. Small-cell carcinoma of the prostate: immunohistochemical and electron microscopic studies of 18 cases. Cancer 1987; 59: 977–982.PubMedCrossRefGoogle Scholar
  13. 13.
    Tetu B, Ro JY, Ayala AG, et al. Small-cell carcinoma of the prostate. Part 1: A clinicopathologic study of 20 cases. Cancer 1987; 59: 1803–1809.PubMedCrossRefGoogle Scholar
  14. 14.
    Reyes AO, Humphrey PA. Diagnostic effect of complete histologic sampling of prostate needle biopsy specimens. Am J Clin Pathol 1998; 109: 416–422.PubMedGoogle Scholar
  15. 15.
    Klein EA, Levin HS, Zippe CD, Krishnamurthy V. Prostatic intraepithelial neoplasia. In: Rous SN, ed. Urology Annual 1997. Blackwell Scientific, Oxford, UK, 1997, pp. 81–93.Google Scholar
  16. 16.
    Weinstein MH, Epstein JI. Significance of high-grade prostatic intraepithelial neoplasia on needle biopsies. Hum Pathol 1993; 24: 624–629.PubMedCrossRefGoogle Scholar
  17. 17.
    Wills ML, Hamper UM, Partin AW, Epstein JI. Incidence of high-grade prostatic intraepithelial neoplasia in sextant needle biopsy specimens. Urology 1997; 49: 367–373.PubMedCrossRefGoogle Scholar
  18. 18.
    Qian J, Wollan P, Bostwick DG. The extent and multicentricity of high-grade prostatic intraepithelial neoplasia in clincally localized prostatic adenocarcinoma. Hum Pathol 1997; 28: 143–148.PubMedCrossRefGoogle Scholar
  19. 19.
    Quinn BD, Cho KR, Epstein JI. Relationship of severe dysplasia to stage B adenocarcinoma of the prostate. Cancer 1990; 65: 2328–2337.PubMedCrossRefGoogle Scholar
  20. 20.
    Hall GS, Kramer CE, Walsh PC, Epstein JI. Evaluation of radical prostatectomy specimens: a comparative analysis of various sampling methods. Am J Surg Pathol 1992; 16: 315–324.PubMedCrossRefGoogle Scholar
  21. 21.
    Klein EA, Kupelian PA, Tuason L, Levin HS. Initial dissection of the lateral fascia reduces the positive margin rate in radical prostatectomy. Urology 1998; 51: 766–773.PubMedCrossRefGoogle Scholar
  22. 22.
    Sohayda C, Kupelian PA, Levin HS, Klein EA. Extent of extracapsular extension in localized prostate cancer. Urology 2000; 55: 382–386.PubMedCrossRefGoogle Scholar
  23. 23.
    Epstein JI, Partin AW, Sauvageot J, Walsh PC. Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol 1996; 20: 286–292.PubMedCrossRefGoogle Scholar
  24. 24.
    Humphrey PA, Walther PJ. Adenocarcinoma of the prostate. Part II: Tissue prognosticators. Am J Clin Pathol 1993; 100: 256–269.PubMedGoogle Scholar
  25. 25.
    Humphrey PA, Vollmer RT. Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens. Hum Pathol 1990; 21: 799–804.PubMedCrossRefGoogle Scholar
  26. 26.
    Blute ML, Bostwick DG, Bergstralh EJ, et al. Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology 1997; 50: 733–739.PubMedCrossRefGoogle Scholar
  27. 27.
    Fesseha T, Sakr W, Grignon D, Banerjee M, Wood DP Jr, Pontes JE. Prognostic implications of a positive apical margin in radical prostatectomy specimens. J Urol 1997; 158: 2176–2179.PubMedCrossRefGoogle Scholar
  28. 28.
    Kupelian P, Katcher J, Levin H, Zippe C, Klein E. Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer. Urology 1996; 48: 249–260.PubMedCrossRefGoogle Scholar
  29. 29.
    De Marzo AM, Marchi VL, Epstein JI, Nelson WG. Proliferative inflammatory atrophy of the prostate. Implications for prostatic carcinogenesis. Am J Pathol 1999; 155: 1985–1992.PubMedCrossRefGoogle Scholar
  30. 30.
    Egevad L, Granfors T, Karlberg L, Bergh A, Stattin P. Percent gleason grade 4/5 as prognostic factor in prostate cancer diagnosed at transurethral resection. J Urol 2002; 168: 509–513.PubMedCrossRefGoogle Scholar
  31. 31.
    Murphy WM, Dean PJ, Brasfield JA, Tatum L. Incidental carcinoma of the prostate: how much sampling is adequate? Am J Surg Pathol 1986; 10: 130–174.CrossRefGoogle Scholar
  32. 32.
    Campbell SC, Klein EA, Levin HS, Piedmonte MR. Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology 1995; 46: 352–355.PubMedCrossRefGoogle Scholar
  33. 33.
    Bluestein DL, Bostwick DG, Bergstralh EJ, Oesterling JE. Eliminating the need for bilateral lymphadenectomy in selected patients with prostate cancer. J Urol 1994; 151: 1315–1320.PubMedGoogle Scholar
  34. 34.
    Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer. J Urol 2002; 168: 514–518.PubMedCrossRefGoogle Scholar
  35. 35.
    Magi-Galluzzi C, Sanderson H, Epstein JI. Atypia in nonneoplastic prostate glands after radiotherapy for prostate cancer. Duration of atypia and relation to type of radiotherapy. Am J Surg Pathol 2003; 27: 206–212.PubMedCrossRefGoogle Scholar
  36. 36.
    Murphy WM, Soloway MS, Barrow S. Pathologic changes associated with androgen deprivation therapy for prostate cancer. Cancer 1991; 68: 821–828.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith DM, Murphy WM. Histologic changes in prostate carcinomas treated with Leuprolide (luteinizing hormone-releasing hormone effect). Distinction from poor tumor differentiation. Cancer 1994; 73: 1472–1477.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Howard S. Levin

There are no affiliations available

Personalised recommendations