Abstract
Diagnosis of small prostate cancer foci is a real challenge for pathologists and urologists as it carries the risk of false positive or negative diagnosis with clinical consequences. Diagnosis of small prostate cancer foci requires a strict methodological approach which includes a search for major and minor features under low and high magnification. Ambiguous cases can be further clarified with the use of basal cell immunomarkers complemented by a positive indicator of malignancy. Despite the new diagnostic armamentarium, a few cases will continue to remain doubtful and might require an appropriate rebiopsy.
References
1.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.
2.
Johansson JE: Expectant management of early stage prostatic cancer: Swedish experience. J Urol 1994;152:1753-1756.
3.
Chodak GW, Thisted RA, Gerber GS, Johansson JE, Adolfsson J, Jones GW, Chisholm GD, Moskovitz B, Livne PM, Warner J: Results of clinically localized prostate cancer. N Engl J Med 1994;330:242-248.
4.
Thorson P, Vollmer RT, Arcangeli C, Keetch DW, Humphrey PA: Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up. Mod Pathol 1998;11:543-551.
5.
Weldon VE, Tavel FR, Neuwirth H, Cohen R: Failure of focal prostate cancer on biopsy to predict focal prostate cancer: the importance of prevalence. J Urol 1995;154:1074-1077.
6.
Zackrisson B, Aus G, Bergdahl, Lilja H, Lodding P, Pihl CG, Hugosson J: The risk of finding focal cancer (less than 3 mm) remains high on re-biopsy of patients with persistently increased prostate specific antigen but the clinical significance is questionable. J Urol 2004;171:1500-1503.
7.
Allan RW, Sanderson H, Epstein JI: Correlation of minute (0.5 mm or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density. J Urol 2003;170:370-372.
8.
Boccon-Gibod LM, Dumonceau O, Toublanc M, Ravery V, Boccon-Gibod LA: Micro-focal prostate cancer: a comparison of biopsy and radical prostatectomy specimen features. Eur Urol 2005;48:895-899.
9.
Epstein JI: Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy. Mod Pathol 2004;17:307-315.
10.
Van der Kwast T, Wolters T, Evans A, Roobol M: Single prostate cancer foci on prostate biopsy. Eur Urol Suppl 2008;7:549-556.
11.
Efthimiou I, Skrepetis K, Bournia E: A clinical dilemma; single prostatic ancer focus in biopsy. Interpretation and management. J BUON 2010;15:19-24.
12.
Leroy X, Aubert S, Villers A, Ballereau C, Augusto D, Gosselin B: Minimal focus of adenocarcinoma on prostate biopsy: clinicopathological correlations. J Clin Pathol 2003;56:230-232.
13.
Thorson P, Humphrey PA: Minimal adenocarcinoma in prostate needle biopsy tissue. Am J Clin Pathol 2000;114:896-909.
14.
Algaba F, Epstein J, Aldape HC, Farrow GM, Lopez-Beltran A, Maksem J, Orozco RE, Pacelli A, Pisansky TM, Trias I: Assessment of prostate carcinoma in core needle biopsy-definition of minimal criteria for diagnosis of cancer in biopsy material. Cancer 1996;78:376-381.
15.
Thorson P, Vollmer RT, Arcangeli C, et al: Minimal adenocarcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up. Mod Pathol 1998;11:543-551.
16.
Wolters T, van der Kwast TH, Vissers CJ, Bangma CH, Roobol M, Schröder FH, van Leenders GJ: False-negative prostate needle biopsies: frequency, histopathologic features, and follow-up. Am J Surg Pathol 2010;34:35-43.
17.
Iczkowski KA: Current prostate biopsy interpretation: Criteria for cancer, atypical small acinar proliferation, high grade prostatic intraepithelial neoplasia and use of immunostains. Arch Pathol Lab Med 2006;130:835-842.
18.
Renshaw AA, Santis WF, Richie JP: Clinicopathological characteristics of prostatic adenocarcinoma in men with atypical prostate needle biopsies. J Urol 1998;159:2018-2021.
19.
Chan TY, Epstein JI: Patient and urologist driven second opinion of prostate needle biopsies. J Urol 2005;174:1390-1394.
20.
Wojno KJ, Epstein JI: The utility of basal cell-specific anti-cytokeratin antibody (34 beta E12) in the diagnosis of prostate carcinoma: a review of 228 cases. Am J Surg Pathol 1995;19:251-260.
21.
Garcia FU, Haber MM, Chen X: Prostatic basal cells in the peripheral and transitional zones: zonal variation in morphology and in immunophenotype. Prostate 2007;67:1686-1692.
22.
Kristiansen G: Diagnostic and prognostic molecular biomarkers for prostate cancer. Histopathology 2012;60:125-141.
23.
Shah RB, Zhou M, LeBlanc M, Snyder M, Rubin MA: Comparison of the basal cell-specific markers, 34betaE12 and p63, in the diagnosis of prostate cancer. Am J Surg Pathol 2002;26:1161-1168.
24.
Zhou M, Shah R, Shen R, Rubin MA: Basal cell cocktail (34betaE12 + p63) improves the detection of prostate basal cells. Am J Surg Pathol 2003;27:365-371.
25.
Oliai BR, Kahane H, Epstein JI: Can basal cells be seen in adenocarcinoma of the prostate?: an immunohistochemical study using high molecular weight cytokeratin (clone 34betaE12) antibody. Am J Surg Pathol 2002;26:1151-1160.
26.
Ali TZ, Epstein JI: False positive labeling of prostate cancer with high molecular weight cytokeratin: p63 a more specific immunomarker for basal cells. Am J Surg Pathol 2008;32:1890-1895.
27.
Humphrey PA: Diagnosis of adenocarcinoma in prostate needle biopsy tissue. J Clin Pathol 2007;60:35-42.
28.
Murphy AJ, Hughes CA, Lannigan G, Sheils O, O'Leary J, Loftus B: Heterogeneous expression of alpha-methylacyl-CoA racemase in prostatic cancer correlates with Gleason score. Histopathology 2007;50:243-251.
29.
Gologan A, Bastacky S, McHale T, Yu J, Cai C, Monzon-Bordonaba F, Dhir R: Age-associated changes in alpha-methyl CoA racemase (AMACR) expression in nonneoplastic prostatic tissues. Am J Surg Pathol 2005;29:1435-1441.
30.
Tischler V, Fritzsche FR, Gerhardt J, Jager C, Stephan C, Jung K, Dietel M, Moch H, Kristiansen G: Comparison of the diagnostic value of fatty acid synthase (FASN) with alpha-methylacyl-CoA racemase (AMACR) as prostatic cancer tissue marker. Histopathology 2010;56:811-815.
31.
Wu X, Zayzafoon M, Zhang X, Hameed O: Is there a role for fatty acid synthase in the diagnosis of prostatic adenocarcinoma? A comparison with AMACR. Am J Clin Pathol 2011;136:239-246.
32.
Kristiansen G, Fritzsche FR, Wassermann K, Jager C, Tolls A, Lein M, Stephan C, Jung K, Pilarsky C, Dietel M, Moch H: GOLPH2 protein expression as a novel tissue biomarker for prostate cancer: implications for tissue-based diagnostics. Br J Cancer 2008;99:939-948.
33.
Wise AM, Stamey TA, McNeal JE, Clayton JL: Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 2002;60:264-269.
34.
Ahmed HU: The index lesion and the origin of prostate cancer. N Engl J Med 2009;361:1704-1706.
35.
Liu W, Laitinen S, Khan S, Vihinen M, Kowalski J, Yu G, Chen L, Ewing CM, Eisenberger MA, Carducci MA, Nelson WG, Yegnasubramanian S, Luo J, Wang Y, Xu J, Isaacs WB, Visakorpi T, Bova GS: Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer. Nat Med 2009;15:559-565.
36.
Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP: Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 1993;71(3 Suppl):933-938.
37.
Egevad L, Norberg M, Mattson S, Norlen BJ, Busch C: Estimation of prostate cancer volume by multiple core biopsies before radical prostatectomy. Urology 1998;52:653-658.
38.
Ochiai A, Trpkov K, Yilmaz A, Donnelly B, Babaian RJ: Validation of a prediction model for low volume/low grade cancer: application in selecting patients for active surveillance. J Urol 2007;177:907-910.
39.
Montironi R, Scattoni V, Mazzucchelli R, Lopez-Beltran A, Bostwick DG, Montorsi F: Atypical foci suspicious but not diagnostic of malignancy in prostate needle biopsies (also referred to as “atypical small acinar proliferation suspicious for but not diagnostic of malignancy”). Eur Urol 2006;50:666-674.
40.
Scattoni V, Raber M, Capitanio U, Abdollah F, Roscigno M, Angiolilli D, Maccagnano C, Gallina A, Sacca A, Freschi M, Doglioni C, Rigatti P, Montorsi F: The optimal rebiopsy prostatic scheme depends on patient clinical characteristics: results of a recursive partitioning analysis based on a 24-core systematic scheme. Eur Urol 2011;60:834-841.
41.
Abouassaly R, Tan N, Moussa A, Jones JS: Risk of prostate cancer after diagnosis of atypical glands suspicious for carcinoma on saturation and traditional biopsies. J Urol 2008;180:911-914.
42.
Ching CB, Moussa AS, Li J, Lane BR, Zippe C, Jones JS: Does transrectal ultrasound probe configuration really matter? End fire versus side fire probe prostate cancer detection rates. J Urol 2009;181:2077-2082.
© 2013 S. Karger AG, Basel
2013
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