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Tsampoukas G, Manolas V, Brown D, Dellis A, Deliveliotis K, Moussa M, Papatsoris A. Atypical small acinar proliferation and its significance in pathological reports in modern urological times. Asian J Urol 2021; 9:12-17. [PMID: 35198392 PMCID: PMC8841244 DOI: 10.1016/j.ajur.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/11/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports, suggestive but not definitive for cancer. The terminology corresponds to some uncertainty in the biopsy report, as the finding might represent an underlying non-cancerous pathology mimicking cancer or an under-sampled prostate cancer site. Therefore, traditional practice favors an immediate repeat biopsy. However, in modern urological times, the need of urgent repeat biopsy is being challenged by some authors as in the majority of cases, the grade of cancer found in subsequent biopsy is reported to be low or the disease to be non-significant. On the other hand, high risk disease cannot be excluded, whereas no clinical or pathological factors can predict the final outcome. In this review, we discuss the significance of the diagnosis of atypical small acinar proliferation in the biopsy report, commenting on its importance in modern urological practice.
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Affiliation(s)
- Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Corresponding author. U-merge Ltd. (Urology for Emerging Countries), London, UK.
| | - Victor Manolas
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
- Department of Urology, Broomfield Hospital, Chelmsford, UK
| | - Athanasios Dellis
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology and General Surgery, Areteion Hospital, Athens, Greece
| | - Konstantinos Deliveliotis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Moussa
- Chairman of Surgery & Urology Department, Lebanese University & Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Schwartzmann I, Celma A, Gallardo I, Moreno O, Regis L, Placer J, Planas J, Trilla Herrero E, Morote Robles J. In Search for risk predictors at the microscopic scenario of a negative biopsy. A systematic review. Actas Urol Esp 2019; 43:337-347. [PMID: 31109736 DOI: 10.1016/j.acuro.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/04/2018] [Accepted: 01/05/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyse the current evidence of their association with the risk of detecting PC in subsequent PBs. EVIDENCE ACQUISITION Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1,015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. EVIDENCE SYNTHESIS Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13 to 42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. CONCLUSIONS The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB.
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Wiener S, Haddock P, Cusano J, Staff I, McLaughlin T, Wagner J. Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue. Urology 2017; 110:161-165. [DOI: 10.1016/j.urology.2017.08.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/01/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
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The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries. Cancer Causes Control 2017; 28:1187-1193. [PMID: 29119339 DOI: 10.1007/s10552-017-0972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. METHOD We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. RESULTS Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. CONCLUSION This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.
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Sanguedolce F, Cormio A, Musci G, Troiano F, Carrieri G, Bufo P, Cormio L. Typing the atypical: Diagnostic issues and predictive markers in suspicious prostate lesions. Crit Rev Clin Lab Sci 2017; 54:309-325. [PMID: 28828885 DOI: 10.1080/10408363.2017.1363155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As much as 5% of prostate biopsies yield findings equivocal for malignancy even for skilled uropathologist; such "grey zone" lesions have been addressed in many ways, although the acronym ASAP (atypical small acinar proliferation) is the most widely used when referring to an atypical focus suspicious, but not diagnostic, for malignancy. Since the introduction of this diagnostic category more than 20 years ago, debate has ensued over its histological characterization and clinical significance. Pathology reporting of ASAP, commonly based on strict morphological criteria and traditional immunohistochemical markers such as basal cell antibodies, has been improved by recent availability of novel immunohistochemical markers such as AMACR and ERG. Further pathological issues, such as the role of pre-analytical variables, number of tissue levels, interobserver variability, and association with prostatic intraepithelial neoplasia also play a role in the optimal assessment of ASAP. Apart from diagnostic issues, a major issue is ASAP predictive value for prostate cancer on repeat biopsy. Therefore, attempts have been made to identify clinical and biological parameters that could predict subsequent diagnosis of malignancy as well as define time and modality of repeat biopsy. Finally, pathological features of cancers detected after a previous ASAP diagnosis are compared with those diagnosed at first prostate biopsy.
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Affiliation(s)
| | - Antonella Cormio
- b Department of Biosciences, Biotechnologies, and Biopharmaceutics , University of Bari , Bari , Italy
| | - Giovanni Musci
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Francesco Troiano
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Giuseppe Carrieri
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Pantaleo Bufo
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Luigi Cormio
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
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Burks FN, Hu JC, Telang D, Liu A, Hawken S, Montgomery Z, Linsell S, Montie JE, Miller DC, Ghani KR. Repeat Prostate Biopsy Practice Patterns in a Statewide Quality Improvement Collaborative. J Urol 2017; 198:322-328. [DOI: 10.1016/j.juro.2017.02.3338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Frank N. Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Jonathan C. Hu
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Dinesh Telang
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Alice Liu
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Scott Hawken
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Zack Montgomery
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Susan Linsell
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - James E. Montie
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - David C. Miller
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
| | - Khurshid R. Ghani
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
- Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan
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Foroozan M, Roudi R, Abolhasani M, Gheytanchi E, Mehrazma M. Clinical significance of endothelial cell marker CD34 and mast cell marker CD117 in prostate adenocarcinoma. Pathol Res Pract 2017; 213:612-618. [PMID: 28552539 DOI: 10.1016/j.prp.2017.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/27/2017] [Accepted: 04/26/2017] [Indexed: 02/07/2023]
Abstract
Prostate cancer is the second cause of cancer-related deaths in men and this is attributed to its aggressiveness and metastatic identity. Our objective was to evaluate the expression patterns of endothelial cell marker CD34 and mast cell marker CD117 in prostate adenocarcinoma (PCa) compared to benign prostate tissue and their relation to the clinicopathological features. A total of 90 prostate samples, including 45 PCa and 45 benign prostate tissues were immunohistochemically examined for the detection of CD34 and CD117 markers. The expression of these markers was also correlated with clinicopathological parameters. Significant overexpression of CD34 was found in PCa group compared to benign prostate tissues (P≤0.001). The expression of CD34 and CD117 in PCa with advanced Gleason score was more than PCa with early Gleason score (P=0.02 and P=0.005, respectively). A significant positive correlation was observed between CD34 expression and the level of total serum prostate specific antigen (sPSA) (P=0.006). In addition, CD34High/CD117High phenotype was frequently observed in PCa cases compared to benign prostate tissues (P≤0.001). There was a positive significant association between CD34High/CD117High phenotype with advanced Gleason score (P≤0.001) and total sPSA level (P=0.02). Our findings showed that increased expression of CD34 and CD117 markers confer tumor progression and aggressiveness on PCa. These molecules may be good candidates for targeted therapy of PCa patients.
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Affiliation(s)
- Mozhdeh Foroozan
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Raheleh Roudi
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Elmira Gheytanchi
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mitra Mehrazma
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Pathology, Iran University of Medical Sciences, Tehran, Iran.
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Kervancioglu E, Kosan M, Erinanc H, Gonulalan U, Oguzulgen AI, Coskun EZ, Ozkardes H. Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer. Kaohsiung J Med Sci 2016; 32:74-9. [PMID: 26944325 DOI: 10.1016/j.kjms.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022] Open
Abstract
Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular-endothelial-growth-factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re-PBx). We retrospectively evaluated 167 patients with re-PBx according to elevated prostate-specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re-PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re-PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate-specific-antigen values. The mean VEGF scores of the cancer and control groups were 232.64 ± 11.14 and 183.09 ± 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 ± 17.59 n/mm(2) and 197.33 ± 16.26 n/mm(2), respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate-biopsy samples of patients with PCA diagnosed with re-PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re-PBx. The expression level of VEGF and MVD should be kept in mind as PCA-related histopathological changes that indicate the increased angiogenesis in prostatic tissue.
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Affiliation(s)
- Enis Kervancioglu
- Department of Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Murat Kosan
- Department of Urology, Baskent University Faculty of Medicine, Ankara and Konya, Turkey
| | - Hilal Erinanc
- Department of Pathology, Başkent University School of Medicine, Ankara, Turkey
| | - Umut Gonulalan
- Department of Urology, Baskent University Faculty of Medicine, Ankara and Konya, Turkey.
| | | | - Esra Zeynep Coskun
- Department of Pathology, Başkent University School of Medicine, Ankara, Turkey
| | - Hakan Ozkardes
- Department of Urology, Baskent University Faculty of Medicine, Ankara and Konya, Turkey
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High Grade Prostatic Intraepithelial Neoplasia and Atypical Glands. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Raskolnikov D, Rais-Bahrami S, George AK, Turkbey B, Shakir NA, Okoro C, Rothwax JT, Walton-Diaz A, Siddiqui MM, Su D, Stamatakis L, Yan P, Kruecker J, Xu S, Merino MJ, Choyke PL, Wood BJ, Pinto PA. The role of image guided biopsy targeting in patients with atypical small acinar proliferation. J Urol 2015; 193:473-478. [PMID: 25150645 PMCID: PMC7641878 DOI: 10.1016/j.juro.2014.08.083] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Men diagnosed with atypical small acinar proliferation are counseled to undergo early rebiopsy because the risk of prostate cancer is high. However, random rebiopsies may not resample areas of concern. Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy offers an opportunity to accurately target and later retarget specific areas in the prostate. We describe the ability of magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy to detect prostate cancer in areas with an initial diagnosis of atypical small acinar proliferation. MATERIALS AND METHODS Multiparametric magnetic resonance imaging of the prostate and magnetic resonance imaging/transrectal ultrasound fusion guided biopsy were performed in 1,028 patients from March 2007 to February 2014. Of the men 20 met the stringent study inclusion criteria, which were no prostate cancer history, index biopsy showing at least 1 core of atypical small acinar proliferation with benign glands in all remaining cores and fusion targeted rebiopsy with at least 1 targeted core directly resampling an area of the prostate that previously contained atypical small acinar proliferation. RESULTS At index biopsy median age of the 20 patients was 60 years (IQR 57-64) and median prostate specific antigen was 5.92 ng/ml (IQR 3.34-7.48). At fusion targeted rebiopsy at a median of 11.6 months 5 of 20 patients (25%, 95% CI 6.02-43.98) were diagnosed with primary Gleason grade 3, low volume prostate cancer. On fusion rebiopsy cores that directly retargeted areas of previous atypical small acinar proliferation detected the highest tumor burden. CONCLUSIONS When magnetic resonance imaging/transrectal ultrasound fusion guided biopsy detects isolated atypical small acinar proliferation on index biopsy, early rebiopsy is unlikely to detect clinically significant prostate cancer. Cores that retarget areas of previous atypical small acinar proliferation are more effective than random rebiopsy cores.
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Affiliation(s)
- Dima Raskolnikov
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nabeel A Shakir
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chinonyerem Okoro
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason T Rothwax
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel Su
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lambros Stamatakis
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pingkun Yan
- Philips Research North America, Briarcliff Manor, New York
| | | | - Sheng Xu
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Clinical Center, National Institutes of Health, Bethesda, Maryland.
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Amin MB, Lin DW, Gore JL, Srigley JR, Samaratunga H, Egevad L, Rubin M, Nacey J, Carter HB, Klotz L, Sandler H, Zietman AL, Holden S, Montironi R, Humphrey PA, Evans AJ, Epstein JI, Delahunt B, McKenney JK, Berney D, Wheeler TM, Chinnaiyan AM, True L, Knudsen B, Hammond MEH. The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Arch Pathol Lab Med 2014; 138:1387-405. [PMID: 25092589 DOI: 10.5858/arpa.2014-0219-sa] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Prostate cancer remains a significant public health problem. Recent publications of randomized trials and the US Preventive Services Task Force recommendations have drawn attention to overtreatment of localized, low-risk prostate cancer. Active surveillance, in which patients undergo regular visits with serum prostate-specific antigen tests and repeat prostate biopsies, rather than aggressive treatment with curative intent, may address overtreatment of low-risk prostate cancer. It is apparent that a greater awareness of the critical role of pathologists in determining eligibility for active surveillance is needed. OBJECTIVES To review the state of current knowledge about the role of active surveillance in the management of prostate cancer and to provide a multidisciplinary report focusing on pathologic parameters important to the successful identification of patients likely to succeed with active surveillance, to determine the role of molecular tests in increasing the safety of active surveillance, and to provide future directions. DESIGN Systematic review of literature on active surveillance for low-risk prostate cancer, pathologic parameters important for appropriate stratification, and issues regarding interobserver reproducibility. Expert panels were created to delineate the fundamental questions confronting the clinical and pathologic aspects of management of men on active surveillance. RESULTS Expert panelists identified pathologic parameters important for management and the related diagnostic and reporting issues. Consensus recommendations were generated where appropriate. CONCLUSIONS Active surveillance is an important management option for men with low-risk prostate cancer. Vital to this process is the critical role pathologic parameters have in identifying appropriate candidates for active surveillance. These findings need to be reproducible and consistently reported by surgical pathologists with accurate pathology reporting.
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Affiliation(s)
- Mahul B Amin
- From the Departments of Pathology and Laboratory Medicine (Drs Amin and Knudsen), Radiation Oncology (Dr Sandler), Urology (Dr Holden), and Biomedical Sciences (Dr Knudsen), Cedars-Sinai Medical Center, Los Angeles, California; the Departments of Urology (Drs Lin and Gore) and Pathology (Dr True), University of Washington, Seattle; Trillium Health Partners, Mississauga, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada (Dr Srigley); Aquesta Pathology, Toowong, Queensland, Australia, and the University of Queensland, Brisbane (Dr Samaratunga); the Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden (Dr Egevad); the Institute for Precision Medicine and the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, Ithaca, New York, and New York-Presbyterian Hospital, New York (Dr Rubin); the Departments of Surgery (Dr Nacey) and Pathology and Molecular Medicine (Dr Delahunt), Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand; the James Buchanan Brady Urological Institute (Dr Carter) and the Departments of Pathology (Dr Epstein), Urology (Dr Epstein), and Oncology (Dr Epstein), Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Urology, the Sunnybrook Health Sciences Centre (Dr Klotz) and the University Health Network (Dr Evans), University of Toronto, Toronto, Ontario, Canada; the Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Zietman); the Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region, Ancona, Italy (Dr Montironi); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Humphrey); the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Dr McKenney); the Department of Cell
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13
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Compérat E, Varinot J, Srigley JR. [Benign mimickers of the prostate cancer. Diagnostic challenges]. Ann Pathol 2013; 33:237-46. [PMID: 23954116 DOI: 10.1016/j.annpat.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 11/18/2022]
Abstract
The diagnosis of prostate cancer (PCa), especially limited adenocarcinoma on needle biopsy, is often challenging. Before making diagnosis of PCa, it is prudent for the pathologist to consider different benign patterns that may lead to a false positive interpretation. Histoanatomic structures such as seminal vesicles, Cowper's glands and paraganglia along with hyperplasia, atrophy with its different patterns and adenosis may generate difficulties in differential diagnosis. Furthermore, inflammatory processes and post-treatment changes may cause problems. The above entities can in some instances simulate low-grade and less commonly high grade PCa. Knowledge of these patterns and application of appropriate immunohistochemistry will lead the pathologist to a correct diagnosis.
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Affiliation(s)
- Eva Compérat
- Service d'anatomie pathologique, hôpital La Pitié-Salpêtrière, UMPC Paris VI, Paris, France.
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Kumar N, Chornokur G. Molecular Targeted Therapies Using Botanicals for Prostate Cancer Chemoprevention. TRANSLATIONAL MEDICINE (SUNNYVALE, CALIF.) 2012; Suppl 2:005. [PMID: 24527269 PMCID: PMC3920581 DOI: 10.4172/2161-1025.s2-005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In spite of the large number of botanicals demonstrating promise as potential cancer chemopreventive agents, most have failed to prove effectiveness in clinical trials. Critical requirements for moving botanical agents to recommendation for clinical use include adopting a systematic, molecular-target based approach and utilizing the same ethical and rigorous methods that are used to evaluate other pharmacological agents. Preliminary data on a mechanistic rationale for chemoprevention activity as observed from epidemiological, in vitro and preclinical studies, phase I data of safety in suitable cohorts, duration of intervention based on time to progression of pre-neoplastic disease to cancer and using a valid panel of biomarkers representing the hypothesized carcinogenesis pathway for measuring efficacy must inform the design of clinical trials. Botanicals have been shown to influence multiple biochemical and molecular cascades that inhibit mutagenesis, proliferation, induce apoptosis, suppress the formation and growth of human cancers, thus modulating several hallmarks of carcinogenesis. These agents appear promising in their potential to make a dramatic impact in cancer prevention and treatment, with a significantly superior safety profile than most agents evaluated to date. The goal of this paper is to provide models of translational research based on the current evidence of promising botanicals with a specific focus on targeted therapies for PCa chemoprevention.
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Affiliation(s)
- Nagi Kumar
- Department of Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Florida, USA ; University of South Florida College of Medicine, Florida, USA
| | - Ganna Chornokur
- Department of Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Florida, USA
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