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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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Sargos P, Supiot S, Créhange G, Fromont-Hankard G, Barret E, Beauval JB, Brureau L, Dariane C, Fiard G, Gauthé M, Mathieu R, Roubaud G, Ruffion A, Renard-Penna R, Neuzillet Y, Rouprêt M, Ploussard G. Oncologic Impact and Safety of Pre-Operative Radiotherapy in Localized Prostate and Bladder Cancer: A Comprehensive Review from the Cancerology Committee of the Association Française d'Urologie. Cancers (Basel) 2021; 13:cancers13236070. [PMID: 34885179 PMCID: PMC8656987 DOI: 10.3390/cancers13236070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Radiotherapy may have an interesting role of reinforcing the loco-regional control of cancer, in addition to surgery, when used as a preoperative treatment. This sequence has demonstrated its efficacy and safety in various malignancies, but no strong data exist in the era of uro-oncology. In this review article, we aim to highlight the potential usefulness of preoperative radiotherapy in prostate and muscle-invasive bladder cancer, aiming to enhance pathological response and local control and to prevent intraoperative tumor seeding. We also emphasize the need for further clinical studies assessing the functional safety of subsequent surgical procedures in a competitive context of new systemic agents that have proven to demonstrate a survival benefit in locally advanced urologic cancers. Abstract Preoperative radiotherapy (RT) is commonly used for the treatment of various malignancies, including sarcomas, rectal, and gynaecological cancers, but it is preferentially used as a competitive treatment to radical surgery in uro-oncology or as a salvage procedure in cases of local recurrence. Nevertheless, preoperative RT represents an attractive strategy to prevent from intraoperative tumor seeding in the operative field, to sterilize microscopic extension outside the organ, and to enhance the pathological and/or imaging tumor response rate. Several clinical works support this research field in uro-oncology. In this review article, we summarized the oncologic impact and safety of preoperative RT in localized prostate and muscle-invasive bladder cancer. Preliminary studies suggest that both modalities can be complementary as initial primary tumor treatments and that a pre-operative radiotherapy strategy could be beneficial in a well-defined population of patients who are at a very high-risk of local relapse. Future prospective trials are warranted to evaluate the oncologic benefit of such a combination of local treatments in addition to new life-prolonging systemic therapies, such as immunotherapy, and new generation hormone therapies. Moreover, the safety and the feasibility of salvage surgical procedures due to non-response or local recurrence after pelvic RT remain poorly evaluated in that context.
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Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France;
| | - Stéphane Supiot
- Department of Radiotherapy, Insitut de Cancérologie de l’Ouest, 44800 St-Herblain, France;
| | - Gilles Créhange
- Department of Radiotherapy, Institut Curie, 75005 Paris, France;
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, 75014 Paris, France;
| | | | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, 97110 Pointe-à-Pitre, France;
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris—Paris University—U1151 Inserm-INEM, Necker, 75015 Paris, France;
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France;
| | - Mathieu Gauthé
- Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM UMR 1153, 75000 Paris, France;
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 35033 Rennes, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | - Alain Ruffion
- Service d’Urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France;
- Equipe 2, Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, 69002 Lyon, France
| | - Raphaële Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, 92151 Suresnes, France;
| | - Morgan Rouprêt
- Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hôpital, 31130 Quint Fonsegrives, France;
- Correspondence: ; Tel.: +33-5-32027202; Fax: +33-5-32027203
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Collins K, Brocken E, Bahler CD, Alabd A, Koch MO, Cheng L. High-intensity focused ultrasound for the treatment of prostate cancer: assessing location of failure after focal therapy in prostate cancer and review of histological characteristics and clinicopathologic correlates after treatment-a 5-year experience. Hum Pathol 2021; 119:79-84. [PMID: 34801600 DOI: 10.1016/j.humpath.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive treatment option used for localized prostate cancer or salvage surgery after failed radiation therapy. Histological changes in post-treatment needle biopsies are reviewed to better understand HIFU failures. Between 2016 and 2021, 50 patients with localized prostate cancer were enrolled and treated in this study. Of these, 10 patients underwent salvage therapy after radiation failure and 7 did not have post-treatment needle biopsies available for review and were excluded. Inclusion criteria included pathologically confirmed prostate cancer and clinical stage T1/T2 disease. We describe the histological changes in post-treatment needle biopsies as part of routine follow-up. Biopsies were examined for presence, distribution and extent of residual adenocarcinoma, Gleason score, and ablative tissue changes. A total of 33 patients underwent HIFU hemi-ablation treatment of localized prostate cancer as primary treatment with post-treatment biopsies available for review. The average mean age of the patients was 64 years (range, 52-81 years). The average PSA (prostate-specific antigen) level of the patients was 6.3 ng/mL (range, 2.4-14.7 ng/mL). The Gleason scores assigned in pretreatment prostate needle biopsies are as follows: 3 + 3 (1 case, 3%), 3 + 4 (21 cases, 64%), 4 + 3 (9 cases, 27%), and 4 + 4 (2 cases, 6%). In post-treatment needle biopsies, 33 cases (100%) showed variable degrees of fibrosis ranging from mild to moderate. Twenty-four of 33 cases (73%) showed necrosis usually associated with acute and/or chronic inflammation. Histological examination of benign glands revealed glandular heterogeneity including atrophy and basal cell hyperplasia. Eight cases (24%) had residual prostatic adenocarcinoma after treatment, of which 4 cases were assigned Gleason score: ≥3 + 4. In cases with residual adenocarcinoma, 8 cases (100%) showed nuclear enlargement, 5 cases (63%), cytoplasmic vacuolization, and 1 case (13%) showed nuclear pyknosis; otherwise, no discernible effects of treatment were seen. Morphological alterations included a spectrum of changes ranging from extensive coagulative stromal necrosis secondary to thermal injury to atrophic changes in benign prostatic tissue after HIFU treatment. Our findings also support the hypothesis that HIFU failure results from inadequate targeting rather than failure within a treated zone.
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Affiliation(s)
- Katrina Collins
- Department of Pathology, Indiana University, Indianapolis, IN, 46202, USA.
| | - Eric Brocken
- Department of Pathology, Indiana University, Indianapolis, IN, 46202, USA
| | - Clinton D Bahler
- Department of Urology, Indiana University, Indianapolis, IN, 46202, USA; Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, 46202, USA
| | - Andre Alabd
- Department of Urology, Indiana University, Indianapolis, IN, 46202, USA
| | - Michael O Koch
- Department of Urology, Indiana University, Indianapolis, IN, 46202, USA
| | - Liang Cheng
- Department of Pathology, Indiana University, Indianapolis, IN, 46202, USA; Department of Urology, Indiana University, Indianapolis, IN, 46202, USA
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Rakauskas A, Shah TT, Peters M, Randeva JS, Hosking-Jervis F, Schmainda MJ, Orczyck C, Emberton M, Arya M, Moore C, Ahmed HU. Can quantitative analysis of multi-parametric MRI independently predict failure of focal salvage HIFU therapy in men with radio-recurrent prostate cancer? Urol Oncol 2021; 39:830.e1-830.e8. [PMID: 34049783 PMCID: PMC8639607 DOI: 10.1016/j.urolonc.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Quantitative mpMRI parameters predict failure of salvage HIFU in radiorecurrent prostate cancer Tumour microenvironment might produce heat-sinks which counter the effect of HIFU Ve value measured in the DCE sequence of the mpMRI is an independent predictor of treatment failure
Objectives Focal salvage HIFU is a feasible therapeutic option in some men who have recurrence after primary radiotherapy for prostate cancer. We aimed to determine if multi-parametric quantitative parameters, in addition to clinical factors, might have a role in independently predicting focal salvage HIFU outcomes. Methods A retrospective registry analysis included 150 consecutive men who underwent focal salvage HIFU (Sonablate500) (2006-2015); 89 had mpMRI available. Metastatic disease was excluded by nodal assessment on pelvic MRI, a radioisotope bone-scan and/or choline or FDG PET/CT scan. All men had mpMRI and either transperineal template prostate mapping biopsy or targeted and systematic TRUS-biopsy. mpMRI included T2‐weighted, diffusion‐weighted and dynamic contrast‐enhancement. Pre-HIFU quantitative mpMRI data was obtained using Horos DICOM Viewer v3.3.5 for general MRI parameters and IB DCE v2.0 plug-in. Progression-free survival (PFS) was defined by biochemical failure and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer‐specific death. Potential predictors of PFS were analyzed by univariable and multivariable Cox-regression. Results Median age at focal salvage HIFU was 71 years (interquartile range [IQR] 65–74.5) and median PSA pre-focal salvage treatment was 5.8ng/ml (3.8-8). Median follow-up was 35 months (23-47) and median time to failure was 15 months (7.8–24.3). D-Amico low, intermediate and high-risk disease was present in 1% (1/89), 40% (36/89) and 43% (38/89) prior to focal salvage HIFU (16% missing data). 56% (50/89) failed by the composite outcome. A total of 22 factors were evaluated on univariable and 8 factors on multivariable analysis. The following quantitative parameters were included: Ktrans, Kep, Ve, Vp, IS, rTTP and TTP. On univariable analysis, PSA, prostate volume at time of radiotherapy failure and Ve (median) value were predictors for failure. Ve represents extracellular fraction of the whole tissue volume. On multivariable analysis, only Ve (median) value remained as an independent predictor. Conclusions One pharmacokinetic quantitative parameter based on DCE sequences seems to independently predict failure following focal salvage HIFU for radio-recurrent prostate cancer. This likely relates to the tumor microenvironment producing heat-sinks which counter the heating effect of HIFU. Further validation in larger datasets and evaluating mechanisms to reduce heat-sinks are required.
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Affiliation(s)
- Arnas Rakauskas
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Jagpal S Randeva
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Clement Orczyck
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline Moore
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Korček M, Sekerešová M, Makarevich AV, Gavurová H, Olexíková L, Pivko J, Barreto L. Morphological and functional alterations of the prostate tissue during clinical progression in hormonally-naïve, hormonally-treated and castration-resistant patients with metastatic prostate cancer. Oncol Lett 2020; 20:201. [PMID: 32963607 PMCID: PMC7491063 DOI: 10.3892/ol.2020.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
Since commony used tools in oncological practice for the diagnosis of castration-resistent prostatic acinar adenocarcinoma are based on clinical criteria, such as castrate testosterone level, continuous rise in serum prostate-specific antigen, progression of preexisting disease or appearance of new metastases, it is important to identify reliable histopathological markers for the identification of this disease. Therefore, the aim of the present study was to determine the association between results from histological analysis, ultrastructural analysis and apoptosis in the prostate of patients with metastatic acinar prostatic adenocarcinoma (mPC). Patients were treated with androgen deprivation therapy (ADT), abiraterone acetate (Abi) therapy or received no treatment. Prostate tissue samples were divided into four groups as follows: i) Group 1, tissues from patients with benign prostatic hyperplasia (adenocarcinoma negative); ii) group 2, tissues from patients with metastatic hormone naïve prostate cancer; iii) group 3, tissues from patients with mPC treated with ADT; and iv) group 4, tissues from patients with metastatic castration-resistant prostate cancer treated with ADT and Abi. Immunohistochemical, terminal deoxynucleotidyl-transferase-mediated dUTP nick end labelling (TUNEL) and ultrastructural assays using light, fluorescence and transmission electron microscopy, respectively, were used to analyze prostate tissue samples. The results demonstrated that ADT and Abi therapy caused histological and ultrastructural changes in prostate tissues. In groups 3 and 4, benign and malignant tissues were affected by the hormonal therapy. Histologically, the malignant epithelium after ADT therapy in groups 3 and 4 presented with a loss of glandular architecture, nuclear and nucleolar shrinkage, chromatin condensation and cytoplasmic clearing. At the ultrastructural level, compact hypertrophic and hyperchromatic nuclei with numerous invaginations were observed in groups 2, 3 and 4. In addition, the incidence of abnormal mitochondria in malignant cells of these groups was high. Group 4 was characterized by the presence of malignant mesenchyme-like cells in the prostatic stroma, arranged in small groups surrounded by collagen fibrils. Furthermore, the cytoplasm of these cells contained filaments. A decrease in the number of apoptotic cells using TUNEL assays in the examined samples was observed with increasing disease progression. The findings from the present study suggest that the duration of treatment with ADT and progression of the disease were associated with apoptosis dysregulation.
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Affiliation(s)
- Michal Korček
- Department of Urology, Faculty Hospital Nitra, 94901 Nitra, Slovak Republic
| | - Monika Sekerešová
- Department of Pathology, Faculty Hospital Nitra, 94901 Nitra, Slovak Republic
| | - Alexander V Makarevich
- Research Institute for Animal Production Nitra, National Agricultural and Food Centre, 95141 Lužianky-near-Nitra, Slovak Republic
| | - Helena Gavurová
- Department of Pathology, Faculty Hospital Nitra, 94901 Nitra, Slovak Republic
| | - Lucia Olexíková
- Research Institute for Animal Production Nitra, National Agricultural and Food Centre, 95141 Lužianky-near-Nitra, Slovak Republic
| | - Juraj Pivko
- Research Institute for Animal Production Nitra, National Agricultural and Food Centre, 95141 Lužianky-near-Nitra, Slovak Republic
| | - Lenka Barreto
- Department of Urology, Faculty Hospital Nitra, 94901 Nitra, Slovak Republic
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7
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Fendler WP, Calais J, Eiber M, Simko JP, Kurhanewicz J, Santos RD, Feng FY, Reiter RE, Rettig MB, Nickols NG, Kishan AU, Slavik R, Carroll PR, Lawhn-Heath C, Herrmann K, Czernin J, Hope TA. False positive PSMA PET for tumor remnants in the irradiated prostate and other interpretation pitfalls in a prospective multi-center trial. Eur J Nucl Med Mol Imaging 2020; 48:501-508. [PMID: 32808077 PMCID: PMC7835157 DOI: 10.1007/s00259-020-04945-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/28/2020] [Indexed: 12/20/2022]
Abstract
Purpose Readers need to be informed about potential pitfalls of [68Ga]Ga-PSMA-11 PET interpretation. Methods Here we report [68Ga]Ga-PSMA-11 PET findings discordant with the histopathology/composite reference standard in a recently published prospective trial on 635 patients with biochemically recurrent prostate cancer. Results Consensus reads were false positive in 20 regions of 17/217 (8%) patients with lesion validation. Majority of the false positive interpretations (13 of 20, 65%) occurred in the context of suspected prostate (bed) relapse (T) after radiotherapy (n = 11); other false positive findings were noted for prostate bed post prostatectomy (T, n = 2), pelvic nodes (N, n = 2), or extra pelvic lesions (M, n = 5). Major sources of false positive findings were PSMA-expressing residual adenocarcinoma with marked post-radiotherapy treatment effect. False negative interpretation occurred in 8 regions of 6/79 (8%) patients with histopathology validation, including prostate (bed) (n = 5), pelvic nodes (n = 1), and extra pelvic lesions (n = 2). Lesions were missed mostly due to small metastases or adjacent bladder/urine uptake. Conclusion [68Ga]Ga-PSMA-11 PET at biochemical recurrence resulted in less than 10% false positive interpretations. Post-radiotherapy prostate uptake was a major source of [68Ga]Ga-PSMA-11 PET false positivity. In few cases, PET correctly detects residual PSMA expression post-radiotherapy, originating however from treated, benign tissue or potentially indolent tumor remnants. Trial registration number ClinicalTrials.gov Identifiers: NCT02940262 and NCT03353740. Electronic supplementary material The online version of this article (10.1007/s00259-020-04945-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wolfgang P Fendler
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany.
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthias Eiber
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jeffrey P Simko
- Department of Anatomic Pathology and Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - John Kurhanewicz
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Romelyn Delos Santos
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Felix Y Feng
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Robert E Reiter
- Department of Urology, UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew B Rettig
- Department of Urology, UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, USA.,Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Nicholas G Nickols
- Department of Urology, UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiation Oncology, VA Greater Los Angeles Healthcare System, University of California Los Angeles, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Roger Slavik
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Courtney Lawhn-Heath
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA.,Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas A Hope
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA
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Dataset for the reporting of prostate carcinoma in radical prostatectomy specimens: updated recommendations from the International Collaboration on Cancer Reporting. Virchows Arch 2019; 475:263-277. [DOI: 10.1007/s00428-019-02574-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
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Egevad L, Judge M, Delahunt B, Humphrey PA, Kristiansen G, Oxley J, Rasiah K, Takahashi H, Trpkov K, Varma M, Wheeler TM, Zhou M, Srigley JR, Kench JG. Dataset for the reporting of prostate carcinoma in core needle biopsy and transurethral resection and enucleation specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR). Pathology 2019; 51:11-20. [DOI: 10.1016/j.pathol.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 01/14/2023]
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10
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Treatment effects in prostate cancer. Mod Pathol 2018; 31:S110-121. [PMID: 29297495 DOI: 10.1038/modpathol.2017.158] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023]
Abstract
Nonsurgical treatments for prostate cancer include androgen-deprivation therapy (ADT), radiation therapy (RT), ablative therapies, chemotherapy, and newly emerging immunotherapies. These approaches can be used alone or in combination depending on the clinical scenario. ADT is typically reserved for high-risk locally or systemically advanced disease that is not amenable to curative surgery. Radiation therapy can be used instead of surgery as primary therapy with curative intent for low-intermediate-risk disease as well as for control of locally advanced disease not suitable for surgery. Ablative therapies can be used as primary therapy for low-intermediate-risk disease or as salvage therapy for clinically localized disease where RT has failed. Chemotherapy and immune-based therapies are currently used for androgen-independent disease, although the indications for these approaches may well change as new data from clinical trials accrue. Pathologists should be able to recognize tissue changes associated with these treatments to provide information that will optimize patient management. This is particularly true in situations where clinical history of recent or remote nonsurgical treatment is not provided with the specimen. In the absence of this information, pathologists encountering the features described herein are encouraged to review patient records or communicate directly with clinical colleagues to determine how a given patient was treated and when.
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Beltran H, Wyatt AW, Chedgy EC, Donoghue A, Annala M, Warner EW, Beja K, Sigouros M, Mo F, Fazli L, Collins CC, Eastham J, Morris M, Taplin ME, Sboner A, Halabi S, Gleave ME. Impact of Therapy on Genomics and Transcriptomics in High-Risk Prostate Cancer Treated with Neoadjuvant Docetaxel and Androgen Deprivation Therapy. Clin Cancer Res 2017; 23:6802-6811. [PMID: 28842510 PMCID: PMC5690882 DOI: 10.1158/1078-0432.ccr-17-1034] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/01/2017] [Accepted: 08/21/2017] [Indexed: 12/14/2022]
Abstract
Purpose: The combination of docetaxel chemotherapy and androgen deprivation therapy (ADT) has become a standard treatment for patients with metastatic prostate cancer. The recently accrued phase III CALGB 90203 trial was designed to investigate the clinical effectiveness of this treatment approach earlier in the disease. Specimens from this trial offer a unique opportunity to interrogate the acute molecular response to docetaxel and ADT and identify potential biomarkers.Experimental Design: We evaluated baseline clinical data, needle biopsies, and radical prostatectomy (RP) specimens from 52 (of 788) patients enrolled on CALGB 90203 at one high volume center. Pathology review, tumor and germline-targeted DNA sequencing (n = 72 genes), and expression profiling using NanoString platform (n = 163 genes) were performed to explore changes in critical prostate cancer pathways linked to aggression and resistance.Results: Three of 52 patients had only microfocal residual cancer at prostatectomy. The most common alterations included TMPRSS2-ERG fusion (n = 32), TP53 mutation or deletion (n = 11), PTEN deletion (n = 6), FOXA1 (n = 6), and SPOP (n = 4) mutation, with no significant enrichment in posttreated specimens. We did not observe AR amplification or mutations. The degree of AR signaling suppression varied among treated tumors and there was upregulation of both AR and AR-V7 expression as well as a subset of neuroendocrine and plasticity genes.Conclusions: These data support the feasibility of targeted and temporal genomic and transcriptome profiling of neoadjuvant-treated prostate cancer with limited formalin-fixed paraffin embedded tissue requirement. Characterization of the heterogeneity of treatment response and molecular outliers that arise posttreatment provides new insight into potential early markers of resistance. Clin Cancer Res; 23(22); 6802-11. ©2017 AACR.
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Affiliation(s)
- Himisha Beltran
- Division of Medical Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York.
| | - Alexander W Wyatt
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmund C Chedgy
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Donoghue
- Division of Medical Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York
| | - Matti Annala
- Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland
| | - Evan W Warner
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Beja
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Sigouros
- Division of Medical Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, New York
| | - Fan Mo
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ladan Fazli
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin C Collins
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Eastham
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Morris
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, Massachusetts
| | - Mary-Ellen Taplin
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York New York
| | - Andrea Sboner
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
- Institute for Computational Biomedicine, Weill Medical College of Cornell University, New York, New York
| | - Susan Halabi
- Alliance Statistics and Data Center and Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Martin E Gleave
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Ellis CL, Harik LR, Cohen C, Osunkoya AO. Biomarker, Molecular, and Technologic Advances in Urologic Pathology, Oncology, and Imaging. Arch Pathol Lab Med 2017; 141:499-516. [PMID: 28157406 DOI: 10.5858/arpa.2016-0263-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urologic pathology is evolving rapidly. Emerging trends include the expanded diagnostic utility of biomarkers and molecular testing, as well as adapting to the plethora of technical advances occurring in genitourinary oncology, surgical practice, and imaging. We illustrate those trends by highlighting our approach to the diagnostic workup of a few selected disease entities that pathologists may encounter, including newly recognized subtypes of renal cell carcinoma, pheochromocytoma, and prostate cancer, some of which harbor a distinctive chromosomal translocation, gene loss, or mutation. We illustrate applications of immunohistochemistry for differential diagnosis of needle core renal biopsies, intraductal carcinoma of the prostate, and amyloidosis and cite encouraging results from early studies using targeted gene expression panels to predict recurrence after prostate cancer surgery. At our institution, pathologists are working closely with urologic surgeons and interventional radiologists to explore the use of intraoperative frozen sections for margins and nerve sparing during robotic prostatectomy, to pioneer minimally invasive videoscopic inguinal lymphadenectomy, and to refine image-guided needle core biopsies and cryotherapy of prostate cancer as well as blue-light/fluorescence cystoscopy. This collaborative, multidisciplinary approach enhances clinical management and research, and optimizes the care of patients with urologic disorders.
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Affiliation(s)
| | | | | | - Adeboye O Osunkoya
- From the Departments of Pathology (Drs Ellis, Harik, Cohen, and Osunkoya), Urology (Dr Osunkoya), and the Winship Cancer Institute (Dr Osunkoya), Emory University School of Medicine, Atlanta, Georgia; and the Department of Pathology, Veterans Affairs Medical Center, Atlanta, Georgia (Dr Osunkoya)
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Billia M, Siddiqui KM, Chan S, Li F, Al-Zahrani A, Gomez JA, Chin JL. Assessment of histopathological features of needle biopsy in recurrent prostate cancer following salvage high-intensity focused ultrasound. Can Urol Assoc J 2016; 10:416-422. [PMID: 28096917 DOI: 10.5489/cuaj.3918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Local recurrence of prostate cancer (PCa) following radiotherapy may be treated with curative intent using salvage high-intensity focused ultrasound (s-HIFU). The interpretation of needle core biopsy specimens following s-HIFU is a daunting task, even for experienced pathologists. We describe various histopathological features encountered in biopsy specimens following whole-gland s-HIFU in one of the largest descriptive studies to date. METHODS Fifty-five patients with biopsy-proven localized radio-recurrent PCa underwent s-HIFU and transrectal ultrasound (TRUS)-guided prostatic needle biopsies at 180 days post-treatment. All biopsies were reviewed by two genitourinary pathologists. RESULTS PCa was detected in 11 (24%) biopsies. Radiation therapy-associated changes were identified in all cases. Additional findings included extensive coagulative stromal necrosis (100%), smudgy chromatin of cancer nuclei (82%), and markedly enlarged bizarre nuclei in the residual cancer (55%). Gleason grade assignment was possible in 10 (91%) of these biopsies and concordance of Gleason grading between pre- and post-therapy specimens was observed in six (60%) cases. CONCLUSIONS The histological interpretation of needle biopsies following salvage HIFU is challenging and requires an understanding of the histopathological changes associated with this procedure in both tumoural and non-tumoural prostatic tissue. Accurate interpretation of the morphological changes following s-HIFU is instrumental for optimization of clinical decision-making and treatment planning in recurrent PCa.
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Affiliation(s)
- Michele Billia
- Department of Surgery, Division of Urologic Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Khurram M Siddiqui
- Department of Surgery, Division of Urologic Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Susanne Chan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Fan Li
- Department of Surgery, Division of Urologic Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Ali Al-Zahrani
- Department of Urology, University of Dammam, Dammam, Saudi Arabia
| | - Jose A Gomez
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Joseph L Chin
- Department of Surgery, Division of Urologic Oncology, London Health Sciences Centre, Western University, London, ON, Canada
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14
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[Analysis and prognostic factors of the specimen of radical prostatectomy in prostate cancer]. Prog Urol 2015; 25:999-1009. [PMID: 26519964 DOI: 10.1016/j.purol.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Handling and pathologic analysis of radical prostatectomy specimens are crucial to confirm the diagnosis of prostate cancer and evaluate prognostic criteria. MATERIAL AND METHODS A systematic review of the scientific literature was performed in the Medline database (PubMed), using different associations of the following keywords: prostate cancer; prostatectomy; specimen; handling; pathology; tumor staging; Gleason score; surgical margin; prognosis; frozen section; lymph node; biomarkers. A particular search was done on specimen management and characterization of tissue prognostic factors. RESULTS Handling of both radical prostatectomy specimen and lymph node dissection is standardized according to international criteria. Although the main histoprognostic factors are still Gleason score, pathologic staging and margin status, these criteria have been refined these last 10 years, allowing to improve the prediction of relapse after surgical treatment. CONCLUSION The standardization of handling and pathology reporting of radical prostatectomy specimens will be mandatory for treatment uniformization according to risk stratification in prostate cancer and personalization of therapeutic approaches.
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Rodrigues Â, Freitas R, Nogueira-Silva P, Jerónimo C, Henrique R. Biopsy sampling and histopathological markers for diagnosis of prostate cancer. Expert Rev Anticancer Ther 2014; 14:1323-36. [PMID: 25278357 DOI: 10.1586/14737140.2014.965688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Prostate cancer is one of the most common malignant tumors and a leading cause of cancer-related morbidity and mortality. Irrespective of the method that allows for risk stratification of prostate cancer suspects, diagnosis relies on tissue sampling through prostate biopsy and subsequent histopathological evaluation. This provides critical information about disease aggressiveness, which is required for adequate patient management. Prostate biopsy methods have significantly evolved over the years, including the definition of indications, sampling schemes and use of imaging techniques (ultrasound and MRI) that allow for more accurate tissue sampling. In response to the challenges emerging from more precise collection of minute prostate tissue samples for analysis, histopathological assessment should include not only the observation of routinely stained sections, but also, and increasingly so, a series of ancillary techniques, especially immunohistochemistry, which increment the accuracy of prostate cancer diagnosis and may provide relevant information to guide patient management.
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Affiliation(s)
- Ângelo Rodrigues
- Department of Pathology, Portuguese Oncology Institute, Rua Dr. António Bernardino Almeida, 4200-072 - Porto, Portugal
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Histologic findings on prostate needle core biopsies following cryotherapy as monotherapy for prostatic adenocarcinoma. Hum Pathol 2013; 44:867-72. [DOI: 10.1016/j.humpath.2012.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/12/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
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Montironi R, Scarpelli M, Mazzucchelli R, Cheng L, Lopez-Beltran A. The spectrum of morphology in non-neoplastic prostate including cancer mimics. Histopathology 2012; 60:41-58. [PMID: 22212077 DOI: 10.1111/j.1365-2559.2011.04000.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The spectrum of morphology in non-neoplastic prostate includes lesions of prostatic epithelial origin, the most common being atrophy, including partial atrophy, adenosis (atypical adenomatous hyperplasia), basal cell hyperplasia and crowded benign glands, as well as those of non-prostatic origin, such as seminal vesicle epithelium. These lesions often mimic lower-grade prostatic adenocarcinoma whereas others, such as granulomatous prostatitis, for example, are in the differential diagnosis of adenocarcinoma, Gleason grades 4 or 5. Diagnostic awareness of the salient histomorphological and relevant immunohistochemical features of these prostatic pseudoneoplasms is critical to avoid rendering false positive diagnoses of malignancy.
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Affiliation(s)
- Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
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18
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Walter B, Weiss T, Hofstädter F, Gaumann A, Hartmann A, Rogenhofer S, Ganzer R, Wach S, Engehausen D, Wieland WF, Blana A. Utility of immunohistochemistry markers in the interpretation of post-high-intensive focussed ultrasound prostate biopsy cores. World J Urol 2012; 31:1129-33. [PMID: 22350516 DOI: 10.1007/s00345-012-0838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 02/02/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To overcome the difficulties in the interpretation of postoperative tumor obtaining biopsy cores for patients who treated their prostate cancer with high-intensity focussed ultrasound (HIFU) therapy. METHODS The H&E slides of 58 patients with residual prostate cancer after HIFU treatment were systematically reviewed. Correlation between the pathologist's findings and immunohistochemical expression of MIB-1, alpha-Methyl-Co-Racemase and 34βE-12 staining was analyzed. RESULTS Mean time from treatment to biopsy was 40.2 (8-208) weeks. The expert review of the H&E slides identified 40 patients with viable carcinoma in the post-HIFU biopsy cores. 18 patients were revised to necrosis-only-tumors. These biopsies were performed not later than 16 weeks after HIFU treatment (median 10.9 weeks, range 8-14). Both MIB-1 and AMACR staining displayed significant differential expression in viable carcinoma (p < 0.001) compared to necrosis tumors. Referring to viable carcinoma tissue, AMACR staining index was significantly rising, the longer treatment dated back from biopsy (p < 0.002). In this context, 34-β-E12 stained negative through all tumor areas and positive in the majority (85%) of the surrounding non-neoplastic epithelium. CONCLUSIONS AMACR and MIB-1 reliably differentiate viable carcinoma from a process of ongoing irreversible necrosis in early post-HIFU prostate biopsy cores and therefore proposed-in addition with 34 beta-E12-as useful markers exposing suspicious tumor foci in difficult cases.
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Affiliation(s)
- B Walter
- Department of Urology, University of Erlangen-Nuremberg, 91054, Erlangen, Germany,
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Suy S, Oermann E, Hanscom H, Lei S, Vahdat S, Yu X, Park HU, Chen V, Collins BT, McGeagh K, Dawson N, Jha R, Azumi N, Dritschilo A, Lynch J, Collins SP. Histopathologic effects of hypofractionated robotic radiation therapy on malignant and benign prostate tissue. Technol Cancer Res Treat 2011; 9:583-7. [PMID: 21070080 DOI: 10.1177/153303461000900606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the first histopathologic analysis of prostatic tissue following hypofractionated robotic radiation therapy. A 66 year-old man presented with stage II, low risk adenocarcinoma of the prostate and underwent elective conformal hypofractionated radiation therapy. His pretreatment evaluation revealed T1c adenocarcinoma, Gleason's grade 3 + 3 = 6 and a prostate specific antigen (PSA) level of 4.87 ng/ml. Hypofractionated radiation therapy (37.5 Gy in five daily fractions of 7.5 Gy) was completed on an Internal Review Board approved protocol. One year later, he developed progressive urinary retention. Transurethral prostatic resection was performed to alleviate obstructive symptoms. Bilobar hypertrophy was observed without evidence of stricture. Histolopathologic analyses of resected prostate tissues revealed changes consistent with radiation treatment, including cellular changes, inflammation, glandular atrophy and hyperplasia. There was no evidence of residual cancer, fibrosis or necrosis. The patient's postoperative course was uneventful with post-treatment PSA of 0.5 ng/ml and residual grade 1 stress incontinence.
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Affiliation(s)
- Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital
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Zechmann CM, Simpfendörfer T, Giesel FL, Zamecnik P, Thieke C, Hielscher T, Meinzer HP, Delorme S. Comparison of peripheral zone and central gland volume in patients undergoing intensity-modulated radiotherapy. J Comput Assist Tomogr 2010; 34:739-45. [PMID: 20861778 DOI: 10.1097/rct.0b013e3181ebd14f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The shrinking effect of androgen deprivation therapy (ADT) and radiotherapy (RT) on prostate gland volume is a known clinical finding. Until now, it is not known which part of the prostate shrinks more. We examined patients with and without ADT undergoing intensity-modulated RT (IMRT) and performed 3-dimensional measurements of the peripheral zone (PZ) and central gland (CG) with magnetic resonance imaging (MRI). METHODS AND MATERIALS Prostate gland volumes of PZ and CG between planning MRI and first available follow-up MRI were retrospectively determined in 44 patients with localized prostate carcinoma. A total of 24 patients had ADT with a median time interval of 5 months (range, 1.5-24 months). Median time interval between both MRI time points was 132 days (range, 104-224 days). Two observers performed PZ and CG delineation in consensus using planimetry. Volume changes over time were determined and compared. RESULTS Patients who had ADT showed smaller prostate volume in the first MRI (mean [SD], 32 [16.7] mL), which was still present after IMRT (28.1 [16.7] mL). Patients who had no ADT started with 44.6 (16.9) mL and showed 37.5 (13.9) mL after IMRT. Shrinking effect in PZ was significantly larger than in CG for all patients (-18.3% vs -6.3%, P < 0.05). CONCLUSIONS Because, typically, most tumors are located in PZ and this area also shows the largest shrinkage effect after IMRT, this should be taken into account for planning purposes. Notably, there are only minor differences in the relative shrinking effects between patients with and without ADT, although they start with different volumes.
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Biermann K, Montironi R, Lopez-Beltran A, Zhang S, Cheng L. Histopathological findings after treatment of prostate cancer using high-intensity focused ultrasound (HIFU). Prostate 2010; 70:1196-200. [PMID: 20564422 DOI: 10.1002/pros.21154] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) treatment is a novel minimally invasive therapeutic option for patients with localized prostate cancer. Little is known about the histological findings in prostate biopsies upon HIFU treatment. METHOD We examined the spectrum of histological changes in prostate biopsies of 25 prostate cancer patients who were previously treated with HIFU. The biopsies were taken 180 days after HIFU treatment. RESULTS Seventy-two percent of the cases showed necrosis, often accompanied by acute, chronic, or granulomatous inflammation. Mild or moderate fibrosis was present in all biopsies. In benign glands, histological examination revealed a heterogeneous cellular damage and cellular response including cytologic atypia and basal cell hyperplasia. Eleven patients (44%) had residual prostatic carcinoma after treatment. In cases with residual adenocarcinoma, the majority of the cases (9/11, 88%) do no have apparent treatment effects. Two cases showed nuclear pyknosis. In summary, we report the histological findings in benign and malignant prostatic tissues after HIFU treatment. These findings include a spectrum of morphological changes ranging from apparent necrosis to more subtle cellular damage can be observed in benign prostatic tissue after HIFU treatment. There were minimal morphologic changes in residual adenocarcinoma after HIFU treatments. CONCLUSION The pathologist should be aware of common histologic findings in prostatic biopsies after HIFU treatment. We recommend routine reporting of Gleason scores in post-HIFU needle biopsies.
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Hameed O, Humphrey PA. Pseudoneoplastic mimics of prostate and bladder carcinomas. Arch Pathol Lab Med 2010; 134:427-43. [PMID: 20196670 DOI: 10.5858/134.3.427] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The differential diagnoses of prostatic carcinoma and bladder epithelial neoplasms include several histologic mimics that should be known to avoid misdiagnosis. OBJECTIVE To discuss pseudoneoplastic lesions of the prostate and bladder that could potentially be confused with prostatic carcinoma and bladder epithelial neoplasms, respectively, with specific focus on their distinguishing histopathologic features. DATA SOURCES Relevant published literature and authors' experience. CONCLUSIONS Pseudoneoplastic lesions in the prostate include those of prostatic epithelial origin, the most common being atrophy, adenosis (atypical adenomatous hyperplasia), basal cell hyperplasia, and crowded benign glands, as well as those of nonprostatic origin, such as seminal vesicle epithelium. Such lesions often mimic lower-grade prostatic adenocarcinoma, whereas others, such as clear cell cribriform hyperplasia and granulomatous prostatitis, for example, are in the differential diagnosis of Gleason adenocarcinoma, Gleason grade 4 or 5. Pseudoneoplastic lesions of the urinary bladder include lesions that could potentially be confused with urothelial carcinoma in situ, such as reactive urothelial atypia, and others, such as polypoid/papillary cystitis, where papillary urothelial neoplasms are the main differential diagnostic concern. Several lesions can mimic invasive urothelial carcinoma, including pseudocarcinomatous hyperplasia, von Brunn nests, and nephrogenic adenoma. Diagnostic awareness of the salient histomorphologic and relevant immunohistochemical features of these prostatic and urinary bladder pseudoneoplasms is critical to avoid rendering false-positive diagnoses of malignancy.
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Affiliation(s)
- Omar Hameed
- Department of Pathology, University of Alabama at Birmingham, 35294-6823, USA.
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Kusumi T, Koie T, Tanaka M, Matsumoto K, Sato F, Kusumi A, Ohyama C, Kijima H. Immunohistochemical detection of carcinoma in radical prostatectomy specimens following hormone therapy. Pathol Int 2008; 58:687-94. [DOI: 10.1111/j.1440-1827.2008.02294.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Molinié V, Mahjoub WK, Balaton A. [Histological modifications observed in prostate after preserving treatments for prostate cancer and their impact on Gleason score interpretation]. Ann Pathol 2008; 28:363-73. [PMID: 19068391 DOI: 10.1016/j.annpat.2008.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
Total prostatectomy remains the main treatment for intermediate risk prostate cancer with a life expectancy greater than 10 years. In other cases non-surgical treatments can be proposed: external radiotherapy (exclusive or combined anti-androgen therapy), brachytherapy with permanent implants, high frequency ultrasounds (HIFU, Ablatherm), cryotherapy or exclusive hormonal treatment. For such patients in case of biological recurrence, prostate biopsies are usually performed in order to affirm the local recurrence. The histological confirmation of persistent tumor is usually required before any treatment: salvage surgery, cryotherapy, and brachytherapy or high intensity focused ultrasound (HIFU). Pathologists must be aware of the histological modifications induced by these different treatments in order to ensure an optimal interpretation of the biopsies. In this review, we describe the modifications observed in the normal prostate and in cancers after these various therapeutic methods, and also after alpha reductase inhibitors proposed as treatment of benign prostate hypertrophy and prostate cancer chemoprevention.
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Affiliation(s)
- Vincent Molinié
- Service de pathologie, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris cedex, France.
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Rapkiewicz A, Gorokhovsky R, Farcon E, Das K. Cytology of metastatic prostate cancer following orchiectomy and antiandrogen therapy: a diagnostic challenge. Diagn Cytopathol 2008; 36:499-502. [PMID: 18528888 DOI: 10.1002/dc.20814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Androgen deprivation therapy induces apoptosis and decreases both cell proliferation and angiogenesis in prostate adenocarcinoma. The molecular alterations following androgen ablation translate into unique cytologic features in both primary and metastatic prostate adenocarcinoma. We describe the cytologic appearance of metastatic prostate carcinoma following both surgical castration and androgen deprivation therapy.
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Affiliation(s)
- Amy Rapkiewicz
- Department of Cytopathology, New York University, New York, USA.
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Bibliography. Current world literature. Adrenal cortex. Curr Opin Endocrinol Diabetes Obes 2008; 15:284-299. [PMID: 18438178 DOI: 10.1097/med.0b013e3283040e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aragon-Ching JB, Gillespie J, Price DK, Chuaqui R, Rodriguez-Canales J, Steinberg SM, Dahut WL, Figg WD. Lack of prognostic significance of prostate biopsies in metastatic androgen independent prostate cancer. BJU Int 2007; 100:1245-8. [PMID: 17850370 DOI: 10.1111/j.1464-410x.2007.07173.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the significance of viable tumour in the prostate of patients with metastatic androgen-independent prostate cancer (AIPC). PATIENTS AND METHODS We evaluated the clinicopathological features, including follow-up, of 40 men with metastatic AIPC who had a transrectal biopsy of the prostate. RESULTS Prostate biopsies (median three cores per biopsy) showed viable tumour in 19 of 40 patients (48%). Of the 18 patients who had received radiotherapy (RT), nine had negative on-study biopsy results. A previous history of RT was not associated with overall survival in patients with biopsy-positive tumours (P = 0.84). Also, there was no statistically significant association between positive or negative biopsy status and overall survival (OS) in these 40 patients (P = 0.39), with a similar median OS of 19.6 months for biopsy-negative and 19.8 months for biopsy-positive patients, respectively. CONCLUSIONS Taking prostate biopsies at the time of documented metastatic AIPC yielded tumour in about half the patients. A previous history of RT was not associated with a negative prostate biopsy; the latter appears to have no influence on the prognosis.
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Affiliation(s)
- Jeanny B Aragon-Ching
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bathesda, MD, USA
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