WHAT'S NEW IN PROSTATE CANCER PATHOLOGY ASSESMENT IN 2006

Czech version

Authors: Jonathan I. Epstein M. D.
Authors‘ workplace: Oncology, The Johns Hopkins Hospital ; Baltimore, MD ; Departments of Pathology, Urology and
Published in: Urol List 2006; 4(4): 5-9

Overview

This review summarizes developments over the last year in the pathology of prostate cancer and its precursors. Issues relating to the pathology are critical in the diagnosis, management, and prognostication of prostate cancer. New data has emerged regarding the pathology of prostate cancer and its precursors. The diagnosis of prostate cancer on needle biopsy has been refined as a result of the recent discovery of AMACR, which preferentially labels adenocarcinoma of the prostate. Modifications and additions to the Gleason grading system were published based on a consensus conference of urological pathologists. Various models have been proposed using Gleason score, clinical findings, as well as measurements of tumor volume on needle biopsy to enhance the prediction in men undergoing radical prostatectomy and to predict “insignificant”. Several studies have confirmed that certain findings in radical prostatectomy are adverse, yet conflicting studies were published as to the independent prognosis of tumor volume. The risk of cancer following a diagnosis of high grade prostatic intraepithelial neoplasia (HGPIN) on needle biopsy has decreased to the point where this author does not recommend a routine repeat needle biopsy within the first year following the diagnosis of HGPIN.

KEY WORDS:
Gleason score, prostatic intraepithelial neoplasia, radical prostatectomy, margins, seminal vesicle invasion, AMACR

Sources

1. Ananthanarayanan V, Deaton RJ, Yang XJ. Alphamethylacyl- CoA racemase (AMACR) expression in normal prostatic glands and high-grade prostatic intraepithelial neoplasia (HGPIN): association with diagnosis of prostate cancer. Prostate 2005; 63: 341-346.

2. Beach R, Gown AM, Peralta-Venturina MN. P504S immunohistochemical detection in 405 prostatic specimens including 376 18-gauge needle biopsies. Am J Surg Pathol 2002; 26: 1588-1596.

3. Farinola MA, Epstein JI. Utility of immunohistochemistry for alpha-methylacyl-CoA racemase in distinguishing atrophic prostate cancer from benign atrophy. Hum Pathol 2004; 35: 1272-1278.

4. Hameed O, Sublett J, Humphrey PA. Immunohistochemical stains for p63 and alpha-methylacyl-CoA racemase, versus a cocktail comprising both, in the diagnosis of prostatic carcinoma: a comparison of the immunohistochemical staining of 430 foci in radical prostatectomy and needle biopsy tissues. Am J Surg Pathol 2005; 29: 579-587.

5. Jiang Z, Woda BA, Wu CL. Discovery and clinical application of a novel prostate cancer marker: alphamethylacyl CoA racemase (P504S). Am J Clin Pathol 2004; 122: 275-289.

6. Jiang Z, Iczkowski KA, Woda BA. P504S immunostaining boosts diagnostic resolution of "suspicious" foci in prostatic needle biopsy specimens. Am J Clin Pathol 2004; 121: 99-107.

7. Kunju LP, Rubin MA, Chinnaiyan AM. Diagnostic usefulness of monoclonal antibody P504S in the workup of atypical prostatic glandular proliferations. Am J Clin Pathol 2003; 120: 737-745.

8. Wu CL, Yang XJ, Tretiakova M. Analysis of alphamethylacyl-CoA racemase (P504S) expression in highgrade prostatic intraepithelial neoplasia. Hum Pathol 2004; 35: 1008-1013.

9. Yang XJ, Laven B, Tretiakova M. Detection of alphamethylacyl- coenzyme A racemase in postradiation prostatic adenocarcinoma. Urology 2003; 62: 282-286.

10. Zhou M, Aydin H, Kanane H. How often does alpha-methylacyl-CoA-racemase contribute to resolving an atypical diagnosis on prostate needle biopsy beyond that provided by basal cell markers? Am J Surg Pathol 2004; 28: 239-243.

11. Herawi M, Kahane H, Cavallo C, Epstein JI. Risk of prostate cancer on 1 st rebiopsy within 1 year following a diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) is related to the number of cores sampled. 2005.

12. Gupta C, Ren JZ, Wojno KJ. Individual submission and embedding of prostate biopsies decreases rates of equivocal pathology reports. Urology 2004; 63: 83-86.

13. Chan TY, Epstein JI. Patient and urologist driven second opinion of prostate needle biopsies. 2005; 174: 1390-1394.

14. Epstein JI, Allsbrook WC jr, Amin MB. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29: 1228-1242.

15. Mosse CA, Magi-Galluzzi C, Tsuzuki T. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 2004; 28: 394-398.

16. Pan CC, Potter SR, Partin AW. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 2000; 24: 563-569.

17. Kunz GM jr, Epstein JI. Should each core with prostate cancer be assigned a separate gleason score? Hum Pathol 2003; 34: 911-914.

18. Emiliozzi P, Maymone S, Paterno A. Increased accuracy of biopsy Gleason score obtained by extended needle biopsy. J Urol 2004; 172: 2224-2226.

19. King CR, McNeal JE, Gill H. Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys 2004; 59: 386-391.

20. Rubin MA, Allory Y, Molinie V. Effects of long-term fmasteride treatment on prostate cancer morphology and clinical outcome. Urology 2005; 66: 930-934.

21. Tsuzuki T, Hernandez DJ, Aydin H. Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination. J Urol 2005; 173: 450-453.

22. Shah O, Robbins DA, Melamed J. The New York University nerve sparing algorithm decreases the rate of positive surgical margins following radical retropubic prostatectomy. J Urol 2003; 169: 2147-2152.

23. Ohori M, Kaftan MW, Koh H. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol 2004; 171: 1844-1849.

24. Freedland SJ, Terns MK, Csathy GS. Preoperative model for predicting prostate specific antigen recurrence after radical prostatectomy using percent of biopsy tissue with cancer, biopsy Gleason grade and serum prostate specific antigen. J Urol 2004; 171: 2215-2220.

25. Lotan Y, Shariat SF, Khoddami SM. The percent of biopsy cores positive for cancer is a predictor of advanced pathological stage and poor clinical outcomes in patients treated with radical prostatectomy. J Urol 2004; 171: 2209-2214.

26. Anast JW, Andriole GL, Bismar TA. Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population? Urology 2004; 64: 544-550.

27. Epstein JI, Sanderson H, Carter HB. Utility of saturation biopsy to predict insignificant cancer at radical prostatectomy. Urology 2005; 66: 356-360.

28. Kikuchi E, Scardino PT, Wheeler TM. Is tumor volume an independent prognostic factor in clinically localized prostate cancer? J Urol 2004; 172: 508-511.

29. Ramos CG, Roehl KA, Antenor JA. Percent carcinoma in prostatectomy specimen is associated with risk of recurrence after radical prostatectomy in patients with pathologically organ confined prostate cancer. J Urol 2004; 172: 137-140.

30. Ferrari MK, McNeal JE, Malhotra SM. Vascular invasion predicts recurrence after radical prostatectomy: stratification of risk based on pathologic variables. Urology 2004; 64: 749-753.

31. Fromont G, Cathelineau X, Rozet F. Impact of margin size on the incidence of local residual tumor after laparoscopic radical prostatectomy. J Urol 2004; 172: 1845-1847.

32. Swindle P, Eastham JA, Ohori M. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 2005; 174: 903-907.

33. Masterson TA, Pettus JA, Middleton RG. Isolated seminal vesicle invasion imparts better outcomes after radical retropubic prostatectomy for clinically localized prostate cancer: prognostic stratification of pt3b disease by nodal and margin status. Urology 2005; 66: 152-155.

34. Aydin H, Tsuzuki T, Hernandez D. Positive proximal (bladder neck) margin at radical prostatectomy confers greater risk of biochemical progression. Urology 2004; 64: 551-555.

35. Poulos CK, Koch MO, Eble JN. Bladder neck invasion is an independent predictor of prostate-specific antigen recurrence. Cancer 2004; 101: 1563-1568.

36. Ng JC, Koch MO, Daggy JK. Perineural invasion in radical prostatectomy specimens: lack of prognostic significance. J Urol 2004; 172: 2249-2251.

37. Cao D, Hafez M, Berg K. Little or no residual prostate cancer at radical prostatectomy: vanishing cancer or switched specimen?: a microsatellite analysis of specimen identity. Am J Surg Pathol 2005; 29: 467-473.

38. Epstein JI, Herawi M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: Implications for patient care. J Urol 2005.

Labels

Paediatric urologist Urology

LYMPHATIC DRAINAGE OF THE PROSTATE

PELVIC LYMPHADENECTOMY IN THE PROSTATE CARCINOMA AND ITS LIMITS

PSA AND EARLY DETECTION OF PROSTATE CARCINOMA

PATHOLOGY OF THE PROSTATE AND ANDROGEN AND ESTROGEN LEVELS

EVIDENCE-BASED CLINICAL APPROACH TO ANDROGEN SUPPRESSION AND RADIOTHERAPY IN MALE PATIENTS WITH LOCALLY ADVANCED OR LOCALIZED CARCINOMA OF THE PROSTATE

Article was published in

Urological Journal

2006 Issue 4