Difference between revisions of "Prostate cancer"
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This article deals with '''prostate cancer'''. The vast majority of prostate cancers are carcinomas, i.e. '''prostatic adenocarcinoma''' ([[AKA]] '''adenocarcinoma of the prostate''', '''prostatic carcinoma'''). | This article deals with '''prostate cancer'''. The vast majority of prostate cancers are carcinomas, i.e. '''prostatic adenocarcinoma''' ([[AKA]] '''adenocarcinoma of the prostate''', '''prostatic carcinoma'''). Benign pathology of the prostate gland is dealt with in the ''[[prostate gland]]'' article. | ||
==General== | ==General== | ||
Revision as of 16:42, 15 October 2012
This article deals with prostate cancer. The vast majority of prostate cancers are carcinomas, i.e. prostatic adenocarcinoma (AKA adenocarcinoma of the prostate, prostatic carcinoma). Benign pathology of the prostate gland is dealt with in the prostate gland article.
General
- Very common.
- Increasing incidence with age - the age in years is an approximation of the percentage of men with prostate cancer.
- Usually an indolent course - most old men die with prostate cancer not from prostate cancer.
Management
The management changes between Gleason 6, 7 & 8; typically, the implications are:
- Gleason 6: watchful waiting or radioactive seeds; surgery if patient wants.
- Gleason 7: do something - often surgery.
- Gleason 8+: bad cancer - do something quickly!
Bottom line:
- You want to be sure when you call something Gleason pattern 4.
Microscopic
Criteria as a list
Major criteria (the ABCs of prostate pathology):[1]
- Architecture.
- Increased gland density.
- Small circular glands.
- In rare subtypes - large branching glands.
- "Infiltrative growth" pattern - malignant glands between benign ones.
- Basal cells lacking.
- Cytological abnormalities:
- Nuclear enlargement.
- Nucleoli.
Minor criteria:[1]
- Nuclear hyperchromasia.
- Wispy blue mucin.
- Image: Wispy blue mucin (nature.com) - from Epstein.[2]
- Pink amorphous secretions.
- Image: Pink amorphous secretions (nature.com) - from Epstein.[2]
- Intraluminal crystalloid.
- Image: Intraluminal crystalloid (nature.com) - from Epstein.[2]
- Amphophilic cytoplasm.
- Amphopilic is said to be bluish-red[3] -- though might also be described as blue-grey.
- Adjacent HGPIN.
- Mitoses - quite rare.
Extent/quantity criteria:
- There is no agreed upon minimum number of glands; however, one paper suggests that agreement among experts is low with 5 or less glands.[4]
- Thus, it has been suggested that six or more glands should be present to diagnose cancer.[4]
Low power features
- Architecture is the key to diagnosing low grade cancer.
- Back-to-back glands or crowding of glands -- think low grade cancer (Gleason pattern 3).
- Sharp transition between gland border and lumen.
- Loss of epithelial folding at the epithelium-gland lumen interface - "punched-out" appearance.
- Eosinophilic debris within the gland lumen (pink amorphous secretions, intraluminal crystalloid).
- Blue-tinged acellular material within the gland lumen (mucin) -- uncommon.
- "Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger.
High power features
- Nuclei.
- Hyperchromatic nuclei (like in HGPIN).
- Nuclear enlargement.
- Difficult to appreciate (if cancer isn't side-by-side with normal prostate).
- Difficult to see if not on high power.
- Nucleoli visible on high power (200x or 100X)
- May be difficult to see - especially if light intensity is low.
- One should not use 400x to look for nucleoli (it is a waste of time + you risk overcalling something benign).
- If I see three good nucleoli in a gland I'm usually confident it is cancer.
- May be difficult to see - especially if light intensity is low.
- Loss of basal cells - diagnostic feature.
- Like in breast pathology (where one looks for loss of myoepithelial cells) - this may be difficult to see.
Notes:
- Mitoses are not a common feature - don't waste time looking for them.
Mimics
Mimics of prostate adenocarcinoma:[5]
| Entity | Key feature | Detailed microscopic | Other | Image |
|---|---|---|---|---|
| Adenosis (AKA atypical adenomatous hyperplasia) | gradual transition between normal & small gland (NOT two populations) | many small glands, lack nuclear size variation, basal layer present | nucleoli may be present; may need to do p63 or 34betaE12 to find basal layer | AAH (webpathology.com) |
| Sclerosing adenosis | gradual transition between normal & small gland (NOT two populations), fibrosis | many small glands, lack nuclear size variation, basal layer present | analogous to sclerosing adenosis of breast (???) | Sclerosing adenosis (webpathology.com) |
| Atrophy | sharp angulation of gland | nuclear hyperchromasia, scant cytoplasm | may appear right beside non-atrophic tissue | Atrophy (webpathology.com), Partial atrophy (webpathology.com) Sclerotic atrophy (webpathology.com) |
| Basal cell hyperplasia | two distinct cell populations (in epithelial component) | abundant epithelial cells; nucleoli in pale ('blue') nuclei of basal cells, glandular cell nuclei darker ('purple') | vaguely similar to epithelial hyperplasia of usual type (EHUT) in breast | BCH (webpathology.com) |
| Bulbourethral gland | no nuclear atypia | clear cytoplasm | apex of prostate | Cowper gland (webpathology.com) |
| Seminal vesicles / ejaculatory ducts | lipofuscin (yellow granular material in cytoplasm), smudge cells (smeared appearance + hyperchromatic) | fern-like arrangement of epithelium (low power), nucleoli, surrounded by muscle, +/- nuclear inclusions | involvement by cancer changes staging, lipofuscin may be present in prostate, often has marked nuc. size var.; location: usu. base of prostate | SV - high mag. (WC), SV - low mag. (WC) |
| Radiation effect | marked nuclear size variation | increased stroma (fibrosis), lack nucleoli ??? | history of Rx; uniform nuc. size with Hx of Rx should raise susp. of cancer | Radiation changes (webpathology.com), Radiation changes (webpathology.com) |
| Prostatitis | inflammatory cells (lymphocytes, plasma cells, PMNs) | no nuclear atypia, normal gland arch. | clinical mimic of cancer (elevated PSA); usu. not a problem for the pathologist | Prostatic inflammation (WC) |
| Vasitis nodosa | sperm within ducts, clinical history (usu. post-vasectomy) | small tubules, nucleoli common, mild atypia, may "invade" vessels, track along nerves | mimics metastatic prostate carcinoma, IHC stains: PSA-, PSAP- | VN (webpathology.com) |
Memory device: AAABBRS = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles.
Gleason grading system
Overview:
- This system is only one any one talks about.
- Score range: 6-10.
- Technically 2-10... but almost no one uses 2-5.
- Reported as on biopsy as: (primary pattern) + (secondary pattern or tertiary pattern with the highest grade) = sum.
- e.g. Gleason score 3+4=7 means: pattern 3 is present and dominant, pattern 4 is the remainder of the tumour - but present in a lesser amount than pattern 3.
- Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern)
- Tertiary Gleason pattern - definition: a pattern that is seen in than 5% of the tumour (volume), that is higher grade than the two dominant patterns.[6]
- The presence of a tertiary patterns adversely affect the prognosis; however, the prognosis is not as bad as when the tertiary pattern is the secondary pattern, i.e. 3+4 tertiary 5 has a better prognosis than 3+5 (with some small amount of pattern 4).[6]
Examples:
- A biopsy has 80% pattern 4, 16% pattern 3 and 4% pattern 5... it would be reported as: 4+5=9.
- A prostatectomy has 80% pattern 4, 16% pattern 3 and 4% pattern 5... it would be reported as: 4+3=7 with tertiary pattern 5.
Testing yourself:
- There is a nice test-yourself quiz from Johns Hopkins: http://162.129.103.34/prostate/.
- It was studied in a paper by Kronz et al.[7]
Gleason pattern 1 & 2
- Use strongly discouraged by a number of GU pathology experts.
Notes:
- Gleason pattern 1 - probably represents what today would be called adenosis.
- Should never be used.
- Gleason pattern 2 - used by few GU pathology experts occasionally.
- Generally, should not be diagnosed on core biopsies.[8]
Gleason pattern 3
- Glands smaller than normal prostate glands + loss of epithelial folding.
- Can draw a line around each gland.
- May have gland branching.
- Glands have a X, U, V or Y shape.
Notes:
- Gland lumina should be seen.
- All cribriform is now, generally, classified as Gleason pattern 4.[8]
Gleason pattern 4
- Loss of gland lumina.
- Gland fusion.
- Benign looking cords ('hypernephroid pattern').
- Cribriform.
- Glomeruloid pattern - resembles a glomerulus.
Notes:
- One gland is not enough to call Gleason 4.
Images:
- Gleason pattern 4 - cribriform (WC).
- Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC).
- Glomeruloid pattern (nature.com).
Gleason pattern 5
- Sheets.
- Must be differentiated from intraductal growth (which like in the breast are well circumscribed nests).
- Single cells.
- May be confused with stromal/lymphocytic infiltration.
- Look for nucleoli, cells should be round (prostatic stroma cells are spindle cells).
- May be confused with stromal/lymphocytic infiltration.
- Cords.
- Nests of cells with necrosis at centre.
Image: Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC).
Special types
Special types of prostate cancer have set Gleason scores:[9]
| Special type | Gleason pattern | Comment |
|---|---|---|
| Ductal carcinoma | 4 | may be graded 3 or 5[10] |
| Mucinous carcinoma | 4 | |
| Sarcomatoid carcinoma | 5 | glands graded separately |
| Signet ring cell carcinoma | 5 | |
| Small cell carcinoma | not graded | may be graded 5[10] |
| Adenosquamous and squamous carcinoma | not graded | |
| Lymphoepithelioma-like carcinoma | not graded | |
| Adenoid cystic carcinoma | not graded | |
| Urothelial carcinoma | not graded | |
| Undifferentiated carcinoma, NOS | not graded |
How to remember the ones that aren't graded - think of Ur Lung carcinomas (Urothelial carcinoma, Lymphoepithelioma-like carcinoma):
- Small cell carcinoma.
- Squamous cell carcinoma.
- Adenosquamous carcinoma.
- Adenoid cystic carcinoma.
Staging parameters and margins
Surgical margins
Main article: Surgical margins
- Positive is tumour touching ink.[11]
- "Close" margins have an increase recurrence risk.
Notes:
- Surgical margin - where the surgeon cut.
- It is possible to have EPE without a positive margin.
- It is possible to have a positive margin without EPE.
Rates and implication
Positivity rate varies substantially (13-44%):
- Norway: 26% -- strong dependence on surgeon volume (18% high case load vs. 44% low case load).[12]
- France: 13-17%.[13]
Note:
- There is likely a strong dependence on stage and grade of cancer, i.e. surgeons that operate more on high grade cancers will probably have a higher margin positive rates.
The impact of positive margins:
- Significant modest negative affect on long-term outcome in node negative cancers (pT2-4 pN0).[14]
- Weaker impact than stage and Gleason score.[15]
Extraprostatic extension
- Abbreviated EPE.
General:
- Extraprostatic extension (EPE) is difficult to assess (in prostatectomy specimens) as there is no consensus definition.
- The prostate does NOT have a well defined capsule.
- Intraobserver agreement for EPE is fair-moderate and lower than for the surgical margin.[16]
- The prostate does NOT have a well defined capsule.
- EPE, typically, upstages tumours from T2x to T3a.
Prostatectomy specimens - EPE is present if there is either:
- A "significant bulge" in the contour of the prostate at low power and no fibromuscular tissue surrounding the malignant cells.
- Malignant cells directly adjacent to peri-prostatic adipose tissue.
Note:
- The prostate, at the apex, may have some skeletal muscle. Thus, it is difficult to define extention... ergo EPE not called at the apex.
Prostate biopsy - EPE is present if:
Seminal vesicle invasion
General:
- Typically upstages to T3b.
Microscopic:
- Tumour must be in the muscle surrounding the epithelial component; tumour in the adventitia (the loose connective tissue surrounding the seminal vesicles) does not count.[19][20]
Notes:
- Invasion of the adventitia (only) would quality as EPE; this is, usually, T3a.
IHC
- AMACR +ve.
- AR +ve -- in prostate confined cancer.
- Usu. -ve in LN +ve disease.[21]
- PSA +ve.
- PSAP +ve.
- May be positive in hindgut neuroendocrine tumours.[22]
- p63 -ve.
- HMWCK (34betaE12) -ve.
Combination immunostains:
Molecular changes in prostate cancer
A fusion gene between TMPRSS2 and ERG is described.[26][27]
- Both genes are on chromosome 21.
- Currently not used diagnostically.
- Fusion gene seen in approximately 50% of prostate cancer.[27]
- A subset of TMPRSS2-ERG known as 2+Edel (seen in ~7% of all prostate cancer cases) predicts poor survival.[28]
Sign out
Prostatectomy specimens
See: CAP checklist.
Biopsy specimens
Important elements - a list:[1]
- Type of cancer, e.g. "prostatic adenocarcinoma, acinar type".
- Gleason score including primary and secondary pattern, e.g. "Gleason score 3+4=7".
- Number of cores and number involved, e.g. "2/3 cores involved by cancer".
- Percent area involved, i.e. how much of the core is cancer, e.g. "75% of specimen is tumour".
- Percent area involved that is Gleason pattern 4 or 5, e.g. "25% of the tumour is Gleason pattern 4 or 5".
- Presence of perineural invasion.
- Presence of extension into fat (extraprostatic extension).
Notes:
- "Percent area involved" may seem like an odd thing to request 'cause it is sampling dependent, i.e. if the radiologist sticks the biopsy needle deeper into the lesion more of the core is positive, but urologists think it is important -- more important than perineural invasion.[29]
Completely negative
A. PROSTATE, RIGHT LATERAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. B. PROSTATE, RIGHT MEDIAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. C. PROSTATE, RIGHT LATERAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE. D. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE. E. PROSTATE, RIGHT LATERAL INTERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. I. PROSTATE, LEFT LATERAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE. J. PROSTATE, LEFT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE. K. PROSTATE, LEFT LATERAL INTERIOR, BIOPSY: - BENIGN PROSTATE TISSUE. L. PROSTATE, LEFT MEDIAL INFERIOR, BIOPSY: - BENIGN PROSTATE TISSUE.
No glands
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN FIBROMUSCULAR TISSUE; - NO PROSTATIC GLANDULAR TISSUE PRESENT.
Inflammation
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE; - FOCAL CHRONIC INFLAMMATION.
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE; - CHRONIC INFLAMMATION.
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE; - ACUTE AND CHRONIC INFLAMMATION.
Positive
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 6/10 (3+3); - 1/1 CORE INVOLVED; APPROXIMATELY 5% OF TISSUE INVOLVED.
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 6/10 (3+3); - 1/1 CORE INVOLVED; APPROXIMATELY 25% OF TISSUE INVOLVED; - PERINEURAL INVASION PRESENT.
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 7/10 (4+3); - 1/1 CORE INVOLVED; APPROXIMATELY 5% OF TISSUE INVOLVED; - PERINEURAL INVASION PRESENT.
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 8/10 (4+4); - 1/1 CORE INVOLVED; APPROXIMATELY 15% OF TISSUE INVOLVED.
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 8/10 (4+4); - 1/1 CORE INVOLVED; APPROXIMATELY 15% OF TISSUE INVOLVED; - PERINEURAL INVASION PRESENT.
TUMOUR SUMMARY - PROSTATE CORE BIOPSIES: - HISTOLOGIC TYPE: ADENOCARCINOMA (ACINAR, NOT OTHERWISE SPECIFIED). - TOTAL GLEASON SCORE: 7. - PRIMARY PATTERN: 4. - SECONDARY PATTERN: 3. - PERCENT OF TUMOUR WITH PATTERN HIGHER THAN GRADE 3: 75%. - NUMBER OF CORES POSITIVE: 10. - TOTAL NUMBER OF CORES: 12. - TOTAL LINEAR MILLIMETERS OF NEEDLE CORE TISSUE: 152 MM. - PERCENT OF NEEDLE CORE TISSUE THAT IS TUMOUR: 44%. - PERIPROSTATIC FAT INVASION: NOT IDENTIFIED. - SEMINAL VESICLE INVASION: SEMINAL VESICLE NOT IDENTIFIED. - LYMPHOVASCULAR INVASION: NOT IDENTIFIED. - PERINEURAL INVASION: PRESENT. - ADDITIONAL FINDINGS: HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, CHRONIC INFLAMMATION (FOCAL).
See also
References
- ↑ 1.0 1.1 1.2 Humphrey PA (January 2007). "Diagnosis of adenocarcinoma in prostate needle biopsy tissue". J. Clin. Pathol. 60 (1): 35–42. doi:10.1136/jcp.2005.036442. PMC 1860598. PMID 17213347. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed.
- ↑ 2.0 2.1 2.2 Epstein JI (March 2004). "Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy". Mod. Pathol. 17 (3): 307–15. doi:10.1038/modpathol.3800050. PMID 14739905. http://www.nature.com/modpathol/journal/v17/n3/full/3800050a.html.
- ↑ URL: http://pancreaticcancer2000.com/page1.htm. Accessed on: 3 June 2010.
- ↑ 4.0 4.1 Van der Kwast, TH.; Evans, A.; Lockwood, G.; Tkachuk, D.; Bostwick, DG.; Epstein, JI.; Humphrey, PA.; Montironi, R. et al. (Feb 2010). "Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies.". Am J Surg Pathol 34 (2): 169-77. doi:10.1097/PAS.0b013e3181c7997b. PMID 20061936.
- ↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 100-3. ISBN 978-0387744858.
- ↑ 6.0 6.1 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 72. ISBN 978-0443066771.
- ↑ Kronz, JD.; Silberman, MA.; Allsbrook, WC.; Bastacky, SI.; Burks, RT.; Cina, SJ.; Mills, SE.; Ross, JS. et al. (Sep 2000). "Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies.". Hum Pathol 31 (9): 1044-50. doi:10.1053/hupa.2000.16278. PMID 11014569.
- ↑ 8.0 8.1 Epstein, JI. (Feb 2010). "An update of the Gleason grading system.". J Urol 183 (2): 433-40. doi:10.1016/j.juro.2009.10.046. PMID 20006878. Cite error: Invalid
<ref>tag; name "pmid20006878" defined multiple times with different content - ↑ Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.
- ↑ 10.0 10.1 URL: https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx. Accessed on: 26 November 2011.
- ↑ Lu, J.; Wirth, GJ.; Wu, S.; Chen, J.; Dahl, DM.; Olumi, AF.; Young, RH.; McDougal, WS. et al. (Jul 2012). "A close surgical margin after radical prostatectomy is an independent predictor of recurrence.". J Urol 188 (1): 91-7. doi:10.1016/j.juro.2012.02.2565. PMID 22578729.
- ↑ Steinsvik, EA.; Axcrona, K.; Angelsen, A.; Beisland, C.; Dahl, A.; Eri, LM.; Haug, ES.; Svindland, A. et al. (Aug 2012). "Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? - Findings from a prospective national study.". Scand J Urol Nephrol. doi:10.3109/00365599.2012.707684. PMID 22860630.
- ↑ Koutlidis, N.; Mourey, E.; Champigneulle, J.; Mangin, P.; Cormier, L. (Jul 2012). "Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience.". Int J Urol. doi:10.1111/j.1442-2042.2012.03102.x. PMID 22860572.
- ↑ Mauermann, J.; Fradet, V.; Lacombe, L.; Dujardin, T.; Tiguert, R.; Tetu, B.; Fradet, Y. (Aug 2012). "The Impact of Solitary and Multiple Positive Surgical Margins on Hard Clinical End Points in 1712 Adjuvant Treatment-Naive pT2-4 N0 Radical Prostatectomy Patients.". Eur Urol. doi:10.1016/j.eururo.2012.08.002. PMID 22901983.
- ↑ Chalfin, HJ.; Dinizo, M.; Trock, BJ.; Feng, Z.; Partin, AW.; Walsh, PC.; Humphreys, E.; Han, M. (Jul 2012). "Impact of surgical margin status on prostate-cancer-specific mortality.". BJU Int. doi:10.1111/j.1464-410X.2012.11371.x. PMID 22788795.
- ↑ Evans, AJ.; Henry, PC.; Van der Kwast, TH.; Tkachuk, DC.; Watson, K.; Lockwood, GA.; Fleshner, NE.; Cheung, C. et al. (Oct 2008). "Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens.". Am J Surg Pathol 32 (10): 1503-12. doi:10.1097/PAS.0b013e31817fb3a0. PMID 18708939.
- ↑ Epstein, JI.; Srigley, J.; Grignon, D.; Humphrey, P. (Sep 2007). "Recommendations for the reporting of prostate carcinoma.". Hum Pathol 38 (9): 1305-9. doi:10.1016/j.humpath.2007.05.015. PMID 17707261.
- ↑ Evans, A. 4 June 2010.
- ↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 409. ISBN 978-0-323-06516-0.
- ↑ Berney, DM.; Wheeler, TM.; Grignon, DJ.; Epstein, JI.; Griffiths, DF.; Humphrey, PA.; van der Kwast, T.; Montironi, R. et al. (Jan 2011). "International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.". Mod Pathol 24 (1): 39-47. doi:10.1038/modpathol.2010.160. PMID 20818343.
- ↑ Fleischmann, A.; Rocha, C.; Schobinger, S.; Seiler, R.; Wiese, B.; Thalmann, GN. (Apr 2011). "Androgen receptors are differentially expressed in Gleason patterns of prostate cancer and down-regulated in matched lymph node metastases.". Prostate 71 (5): 453-60. doi:10.1002/pros.21259. PMID 20878946.
- ↑ Azumi, N.; Traweek, ST.; Battifora, H. (Aug 1991). "Prostatic acid phosphatase in carcinoid tumors. Immunohistochemical and immunoblot studies.". Am J Surg Pathol 15 (8): 785-90. PMID 1712549.
- ↑ URL: http://biocare.net/wp-content/uploads/225DS.pdf. Accessed on: 18 October 2011.
- ↑ URL: http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/. Accessed on: 18 October 2011.
- ↑ URL: http://www.webpathology.com/image.asp?case=96&n=5. Accessed on: 18 October 2011.
- ↑ Yu J, Yu J, Mani RS, Cao Q, Brenner CJ, Cao X, Wang X, Wu L, Li J, Hu M, Gong Y, Cheng H, Laxman B, Vellaichamy A, Shankar S, Li Y, Dhanasekaran SM, Morey R, Barrette T, Lonigro RJ, Tomlins SA, Varambally S, Qin ZS, Chinnaiyan AM (May 2010). "An Integrated Network of Androgen Receptor, Polycomb, and TMPRSS2-ERG Gene Fusions in Prostate Cancer Progression". Cancer Cell 17 (5): 443–54. doi:10.1016/j.ccr.2010.03.018. PMC 2874722. PMID 20478527. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874722/.
- ↑ 27.0 27.1 Online 'Mendelian Inheritance in Man' (OMIM) 602060
- ↑ Attard, G.; Clark, J.; Ambroisine, L.; Fisher, G.; Kovacs, G.; Flohr, P.; Berney, D.; Foster, CS. et al. (Jan 2008). "Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer.". Oncogene 27 (3): 253-63. doi:10.1038/sj.onc.1210640. PMID 17637754.
- ↑ Rubin MA, Bismar TA, Curtis S, Montie JE (July 2004). "Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients?". Am. J. Surg. Pathol. 28 (7): 946–52. PMID 15223967.