48,790
edits
Difference between revisions of "Prostate cancer"
Jump to navigation
Jump to search
m
vauthors
m (vauthors) |
|||
| (53 intermediate revisions by 2 users not shown) | |||
| Line 14: | Line 14: | ||
| Gross = usu. posterior aspect of the prostate - often not apparent at gross | | Gross = usu. posterior aspect of the prostate - often not apparent at gross | ||
| Grossing = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]] | | Grossing = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]] | ||
| Staging = [[prostate cancer staging]] | |||
| Site = [[prostate gland]] | | Site = [[prostate gland]] | ||
| Assdx = | | Assdx = | ||
| Line 24: | Line 25: | ||
| Rads = hypoechoic areas, no apparent abnormality | | Rads = hypoechoic areas, no apparent abnormality | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = good-to-poor (depends on [[Gleason score]] and [[stage]]) | | Prognosis = good-to-poor (depends on [[prostate cancer grading|grade (Gleason score)]] and [[stage]]) | ||
| Other = | | Other = | ||
| ClinDDx = [[prostatitis]], [[nodular hyperplasia of the prostate]] | | ClinDDx = [[prostatitis]], [[nodular hyperplasia of the prostate]] | ||
| Line 82: | Line 83: | ||
Clinical criteria: | Clinical criteria: | ||
*PSA <= 10 ng/mL.<ref name=pmid22314081/> | *PSA <= 10 ng/mL.<ref name=pmid22314081/> | ||
*Negative DRE. | |||
==Gross== | ==Gross== | ||
| Line 140: | Line 142: | ||
<gallery> | <gallery> | ||
Image: Intraluminal eosinophilic crystalloid of prostate gland - high mag.jpg| Intraluminal eosinophilic crystalloid - high mag. (WC) | Image: Intraluminal eosinophilic crystalloid of prostate gland - high mag.jpg| Intraluminal eosinophilic crystalloid - high mag. (WC) | ||
Image: Prostate carcinoma with blue mucin -- very high mag.jpg | Whispy blue mucin - very high mag. (WC) | |||
Image: Prostate carcinoma with blue mucin - a1 -- intermed mag.jpg | Whispy blue mucin - intermed. mag. (WC) | |||
</gallery> | </gallery> | ||
| Line 185: | Line 189: | ||
| many small glands, lack nuclear size variation, basal layer present | | 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 | | nucleoli may be present; may need to do p63 or 34betaE12 to find basal layer | ||
| [ | | [[Image:Adenosis of prostate_--_intermed_mag.jpg|thumb|150px|center| Adenosis of prostate. (WC)]] | ||
|- | |- | ||
| Sclerosing adenosis | | Sclerosing adenosis | ||
| Line 191: | Line 195: | ||
| many small glands, lack nuclear size variation, basal layer present | | many small glands, lack nuclear size variation, basal layer present | ||
| analogous to [[sclerosing adenosis of the breast]]{{fact}} | | analogous to [[sclerosing adenosis of the breast]]{{fact}} | ||
| [http://webpathology.com/image.asp?case=21&n= | | [http://webpathology.com/image.asp?case=21&n=40 Sclerosing adenosis (webpathology.com)] | ||
|- | |- | ||
| [[atrophy of the prostate|Atrophy]] | | [[atrophy of the prostate|Atrophy]] | ||
| Line 203: | Line 207: | ||
| abundant epithelial cells; nucleoli in pale ('blue') nuclei of basal cells, glandular cell nuclei darker ('purple') | | 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 | | vaguely similar to epithelial hyperplasia of usual type (EHUT) in breast | ||
| [[Image: | | [[Image:Basal_cell_hyperplasia_of_prostate_-_high_mag.jpg|thumb|150px|center| Prostatic BCH. (WC)]] | ||
|- | |- | ||
| [[Bulbourethral gland]] | | [[Bulbourethral gland]] | ||
| Line 220: | Line 224: | ||
| marked nuclear size variation | | marked nuclear size variation | ||
| increased stroma (fibrosis), lack nucleoli ??? | | increased stroma (fibrosis), lack nucleoli ??? | ||
| history of Rx; uniform nuc. size with Hx of Rx should raise susp. of cancer | | history of Rx; uniform nuc. size with Hx of Rx should raise susp. of [[postradiation prostatic carcinoma|postradiation cancer]] | ||
| [[Image:Prostate_with_radiation_changes_--_high_mag.jpg|thumb|150px|center|Radiation change. (WC)]] | | [[Image:Prostate_with_radiation_changes_--_high_mag.jpg|thumb|150px|center|Radiation change. (WC)]] | ||
|- | |- | ||
| Line 237: | Line 241: | ||
Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles. | Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles. | ||
===Prostatic adenocarcinoma variants that mimic benign | ===Situations where prostate adenocarcinoma may be missed=== | ||
*[[Atrophic prostate carcinoma]] | Key reasons for false negative prostate samples<ref>{{cite journal |authors=Yang C, Humphrey PA |title=False-Negative Histopathologic Diagnosis of Prostatic Adenocarcinoma |journal=Arch. Pathol. Lab. Med. |volume=144 |issue=3 |pages=326–334 |date=March 2020 |pmid=31729886 |doi=10.5858/arpa.2019-0456-RA |url=}}</ref>: | ||
*[[Pseudohyperplastic adenocarcinoma]] | *Tissue artefacts (try levels and/or IHC): | ||
*[[Foamy gland adenocarcinoma]] | **Crush artefact | ||
*[[PIN-like adenocarcinoma]] | **Thick sections | ||
**Aberrant H&E staining | |||
**Freezing artefact | |||
**Cautery | |||
*Minimal adenocarcinoma (less than 1mm long or involving less than 5% of a core biopsy): | |||
*Prostatic adenocarcinoma variants that mimic benign: | |||
**[[Atrophic prostate carcinoma]] | |||
**[[Pseudohyperplastic adenocarcinoma]] | |||
**[[Foamy gland adenocarcinoma]] | |||
**[[PIN-like adenocarcinoma]] | |||
**Microcystic adenocarcinoma | |||
*Single cells of Gleason 5 adenocarcinoma (missed or mistaken for lymphocytes; try IHC for cytokeratins, prostatic and/or hematologic markers) | |||
*Treatment effect (check clinical information and look for treatment effect in benign glands) | |||
=== | ===Prostate cancer grading=== | ||
{{Main|Prostate cancer grading}} | |||
It covers the ''Gleason grading system'' and the (new) ''prognostic grade groupings''. | |||
===Staging parameters, margins and more=== | ===Staging parameters, margins and more=== | ||
====Surgical margins==== | ====Surgical margins==== | ||
{{Main|Surgical margins}} | {{Main|Surgical margins}} | ||
*Positive is ''tumour touching ink''.† <ref name=pmid22578729>{{Cite journal | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref> | *Positive is ''tumour touching [[ink]]''.† <ref name=pmid22578729>{{Cite journal | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref> | ||
**"Close" margins (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/> | **"Close" margins (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/> | ||
| Line 494: | Line 289: | ||
=====Bladder neck margin===== | =====Bladder neck margin===== | ||
{{Main|Bladder neck invasion}} | |||
:[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/> | :[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/> | ||
*Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }</ref> | *Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref> | ||
*Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | *Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | ||
====Extraprostatic extension==== | ====Extraprostatic extension==== | ||
:Abbreviated ''EPE''. | :Abbreviated ''EPE''. | ||
{{Main|Prostate cancer staging#Extraprostatic extension}} | |||
# | |||
====Seminal vesicle invasion==== | ====Seminal vesicle invasion==== | ||
:Abbreviated ''SVI''. | :Abbreviated ''SVI''. | ||
{{Main|Prostate cancer staging#Seminal vesicle invasion}} | |||
====Perineural invasion==== | ====Perineural invasion==== | ||
| Line 564: | Line 319: | ||
===Prostate markers=== | ===Prostate markers=== | ||
*PSA (prostate specific antigen) +ve. | *[[PSA]] (prostate specific antigen) +ve. | ||
*PSAP (prostatic specific acid phosphatase) +ve. † | *[[PSAP]] (prostatic specific acid phosphatase) +ve. † | ||
*P501S +ve. ‡ | *P501S +ve. ‡ | ||
*NKX3.1 +ve. ‡ | *[[NKX3.1]] +ve. ‡ | ||
Notes: | Notes: | ||
| Line 592: | Line 347: | ||
Other IHC stains: | Other IHC stains: | ||
*AR +ve -- in prostate confined cancer. | *AR +ve -- in prostate confined cancer. | ||
** | **Usually -ve in lymph node +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> | ||
Note: | |||
*Bcl-2 marks basal cells in prostate cancer.<ref name=pmid20189848>{{Cite journal | last1 = Boran | first1 = C. | last2 = Kandirali | first2 = E. | last3 = Yilmaz | first3 = F. | last4 = Serin | first4 = E. | last5 = Akyol | first5 = M. | title = Reliability of the 34βE12, keratin 5/6, p63, bcl-2, and AMACR in the diagnosis of prostate carcinoma. | journal = Urol Oncol | volume = 29 | issue = 6 | pages = 614-23 | month = | year = | doi = 10.1016/j.urolonc.2009.11.013 | PMID = 20189848 }}</ref> | |||
====Prostate carcinoma versus urothelial carcinoma==== | ====Prostate carcinoma versus urothelial carcinoma==== | ||
| Line 606: | Line 364: | ||
*AMACR not useful; it is positive in ~50% of [[UCC]].<ref name=pmid16315020>{{Cite journal | last1 = Langner | first1 = C. | last2 = Rupar | first2 = G. | last3 = Leibl | first3 = S. | last4 = Hutterer | first4 = G. | last5 = Chromecki | first5 = T. | last6 = Hoefler | first6 = G. | last7 = Rehak | first7 = P. | last8 = Zigeuner | first8 = R. | title = Alpha-methylacyl-CoA racemase (AMACR/P504S) protein expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. | journal = Virchows Arch | volume = 448 | issue = 3 | pages = 325-30 | month = Mar | year = 2006 | doi = 10.1007/s00428-005-0129-6 | PMID = 16315020 }}</ref> | *AMACR not useful; it is positive in ~50% of [[UCC]].<ref name=pmid16315020>{{Cite journal | last1 = Langner | first1 = C. | last2 = Rupar | first2 = G. | last3 = Leibl | first3 = S. | last4 = Hutterer | first4 = G. | last5 = Chromecki | first5 = T. | last6 = Hoefler | first6 = G. | last7 = Rehak | first7 = P. | last8 = Zigeuner | first8 = R. | title = Alpha-methylacyl-CoA racemase (AMACR/P504S) protein expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. | journal = Virchows Arch | volume = 448 | issue = 3 | pages = 325-30 | month = Mar | year = 2006 | doi = 10.1007/s00428-005-0129-6 | PMID = 16315020 }}</ref> | ||
*CK7 and CK20 are typically negative in prostate carcinoma, and classically positive in urothelial carcinoma. | *CK7 and CK20 are typically negative in prostate carcinoma, and classically positive in urothelial carcinoma. | ||
*CK34betaE12 may be positive in prostate cancer; 43% of cases in one small series of cases with lymph node metastases.<ref name=pmid9024071>{{Cite journal | last1 = Googe | first1 = PB. | last2 = McGinley | first2 = KM. | last3 = Fitzgibbon | first3 = JF. | title = Anticytokeratin antibody 34 beta E12 staining in prostate carcinoma. | journal = Am J Clin Pathol | volume = 107 | issue = 2 | pages = 219-23 | month = Feb | year = 1997 | doi = | PMID = 9024071 }}</ref> | |||
===Rate of utilization=== | ===Rate of utilization=== | ||
| Line 637: | Line 396: | ||
===Transurethral resection of prostate=== | ===Transurethral resection of prostate=== | ||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- ADENOCARCINOMA, Gleason score 6/10 (3+3); | |||
-- Approximately 2% of tissue involved; | |||
-- Please see tumour summary. | |||
Comment: | |||
The World Health Organization (WHO) grade is: 1 out of 5. | |||
</pre> | |||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- ADENOCARCINOMA, Gleason score 7/10 (3+4); | |||
-- Approximately 4% of tissue involved; | |||
-- Please see tumour summary. | |||
- Benign inflamed urothelium. | |||
Comment: | |||
The World Health Organization (WHO) grade is: 2 out of 5. Gleason pattern 3 represents 90% of the tumour, and Gleason pattern 4 represents 10% of the tumour. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP): | PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP): | ||
| Line 889: | Line 670: | ||
*[[AKA]] ''ductal adenocarcinoma of the prostate''. | *[[AKA]] ''ductal adenocarcinoma of the prostate''. | ||
*[[AKA]] ''prostatic adenocarcinoma, large duct type''. | *[[AKA]] ''prostatic adenocarcinoma, large duct type''. | ||
{{Main|Ductal adenocarcinoma of the prostate gland}} | |||
==PIN-like prostatic ductal adenocarcinoma== | ==PIN-like prostatic ductal adenocarcinoma== | ||
{{Main|High-grade prostatic intraepithelial neoplasia-like ductal adenocarcinoma of the prostate}} | |||
==Foamy gland carcinoma== | ==Foamy gland carcinoma== | ||
| Line 954: | Line 684: | ||
==Mucinous prostate carcinoma== | ==Mucinous prostate carcinoma== | ||
{{Main|Mucinous adenocarcinoma of the prostate}} | |||
==Pseudohyperplastic prostatic adenocarcinoma== | ==Pseudohyperplastic prostatic adenocarcinoma== | ||
*[[AKA]] ''pseudohyperplastic adenocarcinoma''. | *[[AKA]] ''pseudohyperplastic adenocarcinoma''. | ||
{{Main|Pseudohyperplastic prostatic adenocarcinoma}} | |||
==Prostatic signet ring cell carcinoma== | ==Prostatic signet ring cell carcinoma== | ||
| Line 1,021: | Line 714: | ||
*[[Alcian blue stain|Alcian blue]] -- 44% of cases +ve.<ref name=pmid21123640/> | *[[Alcian blue stain|Alcian blue]] -- 44% of cases +ve.<ref name=pmid21123640/> | ||
==Sarcomatoid prostate | ==Sarcomatoid carcinoma of the prostate== | ||
{{Main|Sarcomatoid carcinoma of the prostate}} | |||
==Small cell carcinoma of the prostate gland== | ==Small cell carcinoma of the prostate gland== | ||
{{Main|Small cell carcinoma | {{Main|Small cell carcinoma of the prostate gland}} | ||
==Adenoid cystic/basal cell carcinoma of the prostate== | ==Adenoid cystic/basal cell carcinoma of the prostate== | ||
*Abbreviated ''ACBCC''. | *Abbreviated ''ACBCC''. | ||
{{Main|Adenoid cystic/basal cell carcinoma of the prostate}} | {{Main|Adenoid cystic/basal cell carcinoma of the prostate}} | ||
==Postradiation prostate cancer== | |||
{{Main|Postradiation prostate cancer}} | |||
=Metastatic disease and other cancers of the prostate= | =Metastatic disease and other cancers of the prostate= | ||
==Urothelial carcinoma== | ==Urothelial carcinoma== | ||
{{Main|Urothelial carcinoma | {{Main|Urothelial carcinoma of the urethra}} | ||
=See also= | =See also= | ||