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Difference between revisions of "Prostate gland"
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→Prostatic adenocarcinoma: re-order work on fixing the format
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*[[AKA]] ''prostatic carcinoma''. | *[[AKA]] ''prostatic carcinoma''. | ||
===Criteria as a list=== | ===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. | |||
* Gleason 8+: bad cancer - do something quickly! | |||
Bottom line: You want to be sure when you call something Gleason pattern 4. | |||
Note: | |||
*The usual caveats apply to the above; if the patient is moribund-- nothing is done, if the patient refuses treatment... nothing is done et cetera. | |||
===Microscopic=== | |||
====Criteria as a list==== | |||
Major criteria (the ABCs of prostate pathology):<ref name=pmid17213347>{{cite journal |author=Humphrey PA |title=Diagnosis of adenocarcinoma in prostate needle biopsy tissue |journal=J. Clin. Pathol. |volume=60 |issue=1 |pages=35–42 |year=2007 |month=January |pmid=17213347 |pmc=1860598 |doi=10.1136/jcp.2005.036442 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed}}</ref> | Major criteria (the ABCs of prostate pathology):<ref name=pmid17213347>{{cite journal |author=Humphrey PA |title=Diagnosis of adenocarcinoma in prostate needle biopsy tissue |journal=J. Clin. Pathol. |volume=60 |issue=1 |pages=35–42 |year=2007 |month=January |pmid=17213347 |pmc=1860598 |doi=10.1136/jcp.2005.036442 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed}}</ref> | ||
#Architecture. | #Architecture. | ||
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**Thus, it has been suggested that six or more glands should be present to diagnose cancer.<ref name=pmid20061936/> | **Thus, it has been suggested that six or more glands should be present to diagnose cancer.<ref name=pmid20061936/> | ||
===Low power features=== | ====Low power features==== | ||
*Architecture is the '''key''' to diagnosing low grade cancer. | *Architecture is the '''key''' to diagnosing low grade cancer. | ||
**Back-to-back glands or crowding of glands -- think low grade cancer (Gleason pattern 3). | **Back-to-back glands or crowding of glands -- think low grade cancer (Gleason pattern 3). | ||
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**"Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger. | **"Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger. | ||
===High power features=== | ====High power features==== | ||
*Nuclei. | *Nuclei. | ||
**Hyperchromatic nuclei (like in HGPIN). | **Hyperchromatic nuclei (like in HGPIN). | ||
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Notes: | Notes: | ||
*Mitoses are not a common feature - don't waste time looking for them. | *Mitoses are not a common feature - don't waste time looking for them. | ||
===Mimics=== | ===Mimics=== | ||
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*Adenoid cystic carcinoma. | *Adenoid cystic carcinoma. | ||
===Surgical margins and extraprostatic extension=== | ===Surgical margins and extraprostatic extension=== | ||
Definitions: | Definitions: | ||
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</ref> | </ref> | ||
**The prostate, at the apex, may have some skeletal muscle. Thus, it is difficult to define extention... ergo EPE not called at the apex. | **The prostate, at the apex, may have some skeletal muscle. Thus, it is difficult to define extention... ergo EPE not called at the apex. | ||
===IHC=== | |||
*AMACR +ve. | |||
*AR +ve -- in prostate confined cancer. | |||
**Usu. -ve in LN +ve disease.<ref name=pmid20878946>{{Cite journal | last1 = Fleischmann | first1 = A. | last2 = Rocha | first2 = C. | last3 = Schobinger | first3 = S. | last4 = Seiler | first4 = R. | last5 = Wiese | first5 = B. | last6 = Thalmann | first6 = GN. | title = Androgen receptors are differentially expressed in Gleason patterns of prostate cancer and down-regulated in matched lymph node metastases. | journal = Prostate | volume = 71 | issue = 5 | pages = 453-60 | month = Apr | year = 2011 | doi = 10.1002/pros.21259 | PMID = 20878946 }}</ref> | |||
*PSA +ve. | |||
*PSAP +ve. | |||
**May be positive in hindgut [[neuroendocrine tumour]]s.<ref name=pmid>{{Cite journal | last1 = Azumi | first1 = N. | last2 = Traweek | first2 = ST. | last3 = Battifora | first3 = H. | title = Prostatic acid phosphatase in carcinoid tumors. Immunohistochemical and immunoblot studies. | journal = Am J Surg Pathol | volume = 15 | issue = 8 | pages = 785-90 | month = Aug | year = 1991 | doi = | PMID = 1712549 }}</ref> | |||
*p63 -ve. | |||
*HMWCK (34betaE12) -ve. | |||
Combination immunostains: | |||
*''PIN-4'' -- consists of: CK5 + CK14 + p63 + P504S (AMACR).<ref>URL: [http://biocare.net/wp-content/uploads/225DS.pdf http://biocare.net/wp-content/uploads/225DS.pdf]. Accessed on: 18 October 2011.</ref><ref>URL: [http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/ http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/]. Accessed on: 18 October 2011.</ref><ref>URL: [http://www.webpathology.com/image.asp?case=96&n=5 http://www.webpathology.com/image.asp?case=96&n=5]. Accessed on: 18 October 2011.</ref> | |||
**[[AKA]] ''PIN''. | |||
**[[AKA]] ''CAP''. | |||
***Why '''CAP'''? | |||
****A. '''CA'''ncer of the '''P'''rostate. | |||
===Molecular changes in prostate cancer=== | ===Molecular changes in prostate cancer=== | ||