Diagnóstico ecográfico de la neoplasia prostática y su relación histológica / Ultrasound diagnosis of prostatic neoplasia and histological relationship

Introducción: El desarrollo de la tecnología con el ultrasonido transrectal ha permitido obtener imágenes diagnósticas de la glándula prostática; su interés deriva de la inmensa frecuencia de problemas clínicos, tanto benignos como malignos. El medio diagnóstico del cáncer de próstata se basa en una biopsia dirigida por ultrasonido transrectal en la mayoría de los casos. Objetivo: Determinar los hallazgos ultrasonográficos y su relación con estudios histopatológico en el diagnóstico de la neoplasia prostática, de los pacientes con sospecha, atendidos en la consulta de urooncología. Métodos: Se realizó un estudio descriptivo transversal en pacientes con sospecha clínica de cáncer prostático, procedentes del servicio de urología en el Hospital Celia Sánchez Manduley en el período comprendido entre julio de 2019 a julio de 2021; que acudieron a consulta con indicación de ultrasonido transrectal. El universo estuvo constituido por 105 pacientes. Se utilizaron criterios de inclusión y exclusión para la selección del universo, previo consentimiento informado de los pacientes. Las variables estudiadas fueron: edad, color de la piel, síntomas clínicos, hallazgos del ultrasonido transrectal, relación ecosonográfica- anatomopatológico. Resultados: Predominó el grupo de edad de 60 a 79 años, de la raza negra, con síntomas urinarios obstructivos bajos, con presencia del nódulo hipoecoico. Predominó la localización ultrasonográfica periférica, así como el adenocarcinoma prostático como hallazgos anatomopatológico encontrado a través de la biopsia. Conclusiones: Se demostró correlación ecográfica-histológica y anatomopatológica(AU)

Introduction: The development of transrectal ultrasound technology has made it possible to obtain diagnostic images of the prostate gland; its interest derives from the massive frequency of clinical problems, both benign and malignant. The diagnosis of prostate cancer is based on a transrectal ultrasound-guided biopsy in most cases. Objective: To determine the ultrasonographic findings and the how they relate with histopathological studies in the diagnosis of prostatic neoplasia in suspected patients treated in the uro-oncology clinic. Methods: A cross-sectional descriptive study was carried out in patients with clinical suspicion of prostate cancer, in the urology service at Celia Sánchez Manduley Hospital from July 2019 to July 2021; they attended the consultation with an indication for transrectal ultrasound. The universe consisted of 105 patients. Inclusion and exclusion criteria were used for the selection of the universe, with the prior informed consent of the patients. The variables studied were age, skin color, clinical symptoms, transrectal ultrasound findings, echosonographic-pathological relationship. Results: Predominance was observed of subjects from the age group of 60 to 79 years, black race, with lower obstructive urinary symptoms, and presence of hypoechoic nodule. Peripheral ultrasonographic location prevailed, as well as prostatic adenocarcinoma as pathological findings found through biopsy. Conclusions: Ultrasound-histological and pathological correlation was demonstrated(AU)

Avaliação de fatores de risco e antígeno prostático específico no rastreamento de câncer de próstata / Evaluation of risk factors and prostate-specific antigen in prostate cancerscreening

Introdução: no Brasil, o câncer de maior incidência nos homens é o câncer de próstata (CaP), com 6,9% de mortalidade. Atualmente, discute-se a aplicabilidade do antígeno prostático específico (PSA) em políticas de rastreamento para CaP e os riscos associados ao sobrediagnóstico. Objetivo: correlacionar a dosagem do PSA com fatores de risco, história clínica e a presença de neoplasia prostática. Metodologia: estudo descritivo transversal que analisou, comparativamente, dados clínico-epidemiológicos e níveis séricos de PSA de 200 pacientes. Valores de PSA foram estratificados em três categorias (<2,5, 2,5­10,0 e >10 ng/ml). Resultados: os fatores de risco analisados foram relacionados significativamente com o aumento do PSA e neoplasia prostática. A prevalência de CaP (11%) e hiperplasia prostática (61%) foi observada nos pacientes com maior dosagem de PSA, enquanto 1% dos pacientes apresentou CaP sem alteração do PSA e 4% tiveram CaP com 2,5­10,0 ng/ml de PSA. Maiores níveis séricos do biomarcador foram relacionados a diabetes (70%), hipertensão (77%), uso crônico de medicações (60%) e ausência de exames periódicos (58%). O grupo com PSA >10 ng/ml teve média de idade maior que o primeiro (p = 0,002) e o segundo grupos (p = 0,027). Conclusão: a prevalência de hiperplasia prostática benigna associada à alteração do PSA, e o elevado risco de exames falso-positivos evidenciam a preocupação com o sobrediagnóstico. No contexto dos dados clinico-epidemiológicos avaliados, a possibilidade de resultados falso-positivos e falso-negativos associados à dosagem do PSA deve ser considerada, ressaltando a importância de adoção de exames complementares para rastreio do CaP.

Introduction: in Brazil, the cancer with the highest incidence in men is prostate cancer (PCa), with 6.9% mortality. Currently, the applicability of prostate specific antigen (PSA) in screening policies for PCa and the risks associated with overdiagnosis are discussed. Objective: to correlate the PSA level with risk factors, clinical history and the presence of prostatic neoplasm. Methods: a cross-sectional descriptive study that analyzed, comparatively, clinical-epidemiological data and serum PSA levels of 200 patients. PSA values were stratified into three categories (<2.5, 2.5­10.0 and> 10 ng / ml). Results: the risk factors analyzed were significantly related to the increase in PSA and prostatic neoplasm. The prevalence of PCa (11%) and prostatic hyperplasia (61%) was observed in patients with higher levels of PSA, while 1% of patients had PCa without PSA changes and 4% had PCa with 2.5­10.0 ng/ml PSA. Increased serum levels of the biomarker were related to diabetes (70%), hypertension (77%), chronic use of medications (60%) and periodic exams (58%). The group with PSA> 10 ng/ml had a mean age greater than the first (p = 0.002) and the second group (p = 0.027). Conclusion: the prevalence of benign prostatic hyperplasia associated with PSA change and an increased risk of false-positive tests show a concern with overdiagnosis. In the context of clinical-epidemiological data, the possibility of false-positive and false-negative results associated with the PSA measurement have to be considered, highlighting the importance of complementary tests for PCa screening.

Significance of atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in prostate biopsy in China / 中华男科学杂志

Objective@#To assess the rates of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) detected in prostate biopsy in China and the risk of PCa found in subsequent repeat biopsy.@*METHODS@#A total of 2,456 patients underwent TRUS-guided prostate biopsy with the samples of ASAP and/or HGPIN tissues in our hospital at least twice between July 2014 and June 2019. We analyzed the findings of digital rectal examination, prostate volumes, PSA levels, and the results of prostate biopsies.@*RESULTS@#Initial prostate biopsies revealed 737 cases of PCa (30.0%), 215 cases of ASAP (8.8%), 98 cases of HGPIN (4.0%), and 18 cases of ASAP+HGPIN (0.7%). Totally, 313 of the patients met the inclusion criteria and included in this study. Of the 215 cases of ASAP confirmed in the first biopsy, 72 and 25 were diagnosed with PCa in the second and third biopsies, respectively, 83 with Gleason score (GS) 6, 14 with GS7, 57 with T1c and 40 with T2a tumors. Of the 98 cases of HGPIN confirmed in the first biopsy, 1 was diagnosed with PCa in the second and another 1 in the third biopsy, both with GS6 and T1c tumors. Of the 18 cases of ASAP+HGPIN confirmed in the first biopsy, 7 and 3 were diagnosed with PCa in the second and third biopsies, respectively, 7 with GS6, 3 with GS7, 6 with T1c and 4 with T2a tumors.@*CONCLUSIONS@#ASAP is a significant risk factor for PCa and repeat prostate biopsy should be performed for patients diagnosed with ASAP in the first biopsy. Whether repeat biopsy is necessary for those diagnosed with HGPIN depends on other related clinical parameters./.

Incidencia de adenocarcinoma en zona transicional de próstata en institución pública. Cochabamba, Bolivia / Incidence of Adenocarcinoma in Transitional Zone of Prostate in public

El cáncer en la zona de transición representa el 20-25% de los casos (en piezas de prostatectomías radicales), su diagnóstico con frecuencia es de manera incidental, siendo identificados clínicamente como supuestos adenomas. OBJETIVO: determinar la incidencia de Adenocarcinoma en la Zona transicional de Próstata e identificar etapas precancerosas en pacientes con clínica de HPB. MÉTODS: estudio longitudinal de tipo retrospectivo desde el 2013-2018 en la ciudad de Cochabamba-Bolivia; población de estudio: pacientes sometidos a prostatectomía simple, retropúbica y/o transvesical. Recolección de datos: a partir de historias clínicas, en pacientes con clínica de hiperplasia benigna de próstata y PSA total < 4 ng/ml. RESULTADOS: se identificó 76 pacientes, de los cuales; 5 pacientes resultaron con Adenocarcinoma y 9 pacientes con: Neoplasia Intraepitelial Prostática de Alto Grado 2,6 %, Proliferación acinar pequeña atípica 7,9%, representando así un 10,5%. En cuanto a la invasión representaron un 5,3% con invasión perineal, 2,6% invasión linfovascular y ninguno con invasión extravascular. DISCUSIÓN: pacientes con cáncer de próstata zona transicional, presentan un Antígeno prostático específico alto susceptibles a Adenocarcinoma. Sin embargo, en esta investigación se encontró Adenocarcinoma de próstata de alto riesgo con Antígeno prostático específico total menor a 4 ng/ml. A pesar de los instrumentos clínicos e indicaciones para la decisión de terapia quirúrgica de una supuesta hiperplasia prostática benigna, existe en el estudio una incidencia del 6,5% de Adenocarcinoma en Zona Transicional, con un 10,5 % de incidencia de presentación de formas precancerosas y el 17,1% de los pacientes del estudio se encuentran en riesgo de letalidad de la enfermedad.

Cancer in the transition zone represents 20-25% of cases, its diagnosis is often incidental, being identified clinically as suspected adenomas. OBJECTIVE: to determine the incidence of adenocarcinoma in the transitional Prostate Zone and identify the degree of adenocarcinoma and precancerous stages thereof. METHODS: longitudinal retrospective study from 2013-2018 in the city of Cochabamba-Bolivia; Study population: patients undergoing simple, retropubic and / or transvesical prostatectomy. Data collection: from medical records, in patients with benign prostatic hyperplasia and who have no atypia and neoplasms. RESULTS: 76 patients were identified, of which; 5 patients resulted with adenocarcinoma and 9 patients among: High Grade Prostatic Intraepithelial Neoplasia 2.6%, small atypical acinar proliferation 7.9%, thus representing 10.5%. As for the invasion, they represented 5.3% with perineal invasion, 2.6% lymphovascular invasion and none with extravascular invasion. DISCUSSION: Patients with transitional prostate cancer have a high specific prostate antigen susceptible to adenocarcinoma. However, this investigation found high-risk prostate adenocarcinoma with total prostate antigen total less than 4 ng / ml. Despite the clinical instruments and indications for the decision of surgical therapy of an alleged benign prostatic hyperplasia, there is a 6.5% incidence of adenocarcinoma in the Transitional Area, with a 10.5% incidence of presentation of forms of Proliferation of Atypical Small Acini and 17.1% of the patients in the study are at risk of lethality of the disease.

Association between decreased expression of estrogen receptor alpha, androgen receptor and phosphatase and tensin homolog immunoexpression in the canine prostate / Associação entre diminuição da expressão dos receptores de estrógeno alfa e andrógeno, e imunoexpressão de fosfatase e tensina homóloga na próstata canina

Canine prostate gland is a hormonal dependent organ and its imbalance of estrogen and androgen receptor expressions are directly associated with the development of different diseases. Due to the lack of information regarding the behavior of the aforementioned receptors in canine prostate cancer (PC), this study aimed to identify estrogen receptor alpha (ERα), androgen receptor (AR), Ki67 and phosphatase and tensin homolog (PTEN) protein expressions in canine PC by immunohistochemistry. We found nuclear expression of ERα and AR in the epithelial cells of normal canine samples and a loss of protein expression in PC samples. Normal samples showed Ki67 expression in a few basal cells and the PC samples showed the highest mean of positive cells (253.1). Canine prostate cancer showed a high proliferative index, which was associated with independence of hormonal actuation. PTEN showed positive nuclear and cytoplasmic expression in normal canine samples and a loss in PC. Loss of ERα, AR and PTEN indicated that canine PC exhibits the same immunohistochemical phenotype as in human patients with PC resistant to hormonal therapy. Therefore, canine PC should be considered as a model to study human PC resistant to hormonal therapy.(AU)

A glândula prostática canina é um órgão dependente de hormônio, e o desequilíbrio na expressão dos receptores de estrógeno e andrógeno estão diretamente associados com o desenvolvimento de diferentes doenças. Devido à falta de informação sobre o comportamento desses receptores no câncer prostático canino (PC), este estudo tem por objetivo identificar a expressão proteica através da técnica de imuno-histoquímica do receptor de estrógeno alfa (REα), receptor de andrógeno (RA), Ki67 e fosfatase e tensina homóloga (PTEN). Foi encontrado nas células epiteliais prostáticas normais caninas a expressão nuclear de REα e RA, e perda de expressão proteica nas amostras de PC. As amostras normais apresentaram expressão de Ki67 em poucas células basais e as amostras de PC apresentaram a maior média de células positivas (253,1). O câncer de próstata canino apresentou uma taxa alta de proliferação, o qual foi associado com a atuação independente de hormônio. As amostras de próstatas caninas normais revelaram marcação nuclear e citoplasmática da proteína PTEN e perda nas amostras de PC. A perda de REα, RA e PTEN indicam que as amostras de PC exibem o mesmo fenótipo imuno-histoquímico de pacientes humanos com câncer prostático resistente a terapia hormonal. Sendo assim, o PC canino deve ser considerado um modelo para estudos de câncer prostático humano resistente a terapia hormonal.(AU)

The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia

ABSTRACT Purpose We report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis. Materials and Methods We retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN. Results Among 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users. Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years. Conclusions This preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.

Relación entre ratio digital 2D: 4D y severidad preoperatoria del cáncer de próstata / Relationship between Digit Ratio (2D:4D) and Preoperative Severity of Prostate Cancer

El cociente entre la longitud del segundo y cuarto dedo (2D:4D) de la mano es un rasgo de dimorfismo sexual, presentando los hombres una ratio menor que las mujeres.1 Varios estudios de cohortes2,3 y un metaanálisis,4 han mostrado que la diferencia de género en la ratio de los dedos se asocia con la exposición de andrógenos prenatales. El cociente 2D:4D está inversamente relacionado a la exposición intrauterina de testosterona (T) y directamente relacionado a la de estradiol.2 Existe evidencia que afirma que la ratio 2D:4D podría ser un marcador válido para los niveles hormonales del adulto (T y estrógeno),3 aunque ese dato es controvertido.4Por esa razón, el cociente 2D:4D seha utilizado como un biomarcador no invasivo y retrospectivo para la exposición prenatal de andrógenos, y se ha correlacionado con una amplia gama de enfermedades como el autismo,5 así como la cognición visoespacial y la orientación sexual.6

The quotient between the length of the second and fourth finger (2D:4D) hand is a trait of sexual dimorphism, featuring the men a lower ratio than women.1 Several studies of the cohorts2,3 and a meta-analysis,4 have shown that the difference between The gender ratio of the fingers is associated with the exposure of prenatal androgens. The quotient 2D:4D is inversely related to intrauterine testosterone (T) exposure and directly related to that of estradiol.2 There is evidence which states that the 2D:4D ratio could be a valid marker for adult hormone levels (T and estrogen),3 although that data is controversial.4 For that reason, the 2D:4D quotient has been used as a noninvasive and retrospective biomarker for prenatal exposure to androgens, and it has been correlated with a wide range of diseases such as autism,5 as well as such as visuospatial cognition and sexual orientation.6

Serum testosterone as a biomarker for second prostatic biopsy in men with negative first biopsy for prostatic cancer and PSA>4ng/mL, or with PIN biopsy result

Abstract Introduction: Data from animal, clinical and prevention studies support the role of androgens in prostate cancer growth, proliferation and progression. Results of serum based epidemiologic studies in humans, however, have been inconclusive. The present study aims to define whether serum testosterone can be used as a predictor of a positive second biopsy in males considered for re-biopsy. Material and Methods: The study included 320 men who underwent a prostatic biopsy in our department from October 2011 until June 2012. Total testosterone, free testosterone, bioavailable testosterone and prostate pathology were evaluated in all cases. Patients undergoing a second biopsy were identified and biopsy results were statistically analyzed. Results: Forty men (12.5%) were assessed with a second biopsy. The diagnosis of the second biopsy was High Grade Intraepithelial Neoplasia in 14 patients (35%) and Prostate Cancer in 12 patients (30%). The comparison of prostatic volume, total testosterone, sex hormone binding globulin, free testosterone, bioavailable testosterone and albumin showed that patients with cancer of the prostate had significantly greater levels of free testosterone (p=0.043) and bioavailable T (p=0.049). Conclusion: In our study, higher free testosterone and bioavailable testosterone levels were associated with a cancer diagnosis at re-biopsy. Our results indicate a possible role for free and bioavailable testosterone in predicting the presence of prostate cancer in patients considered for re-biopsy.

Intraductal Carcinoma of the Prostate Gland: Recent Advances

Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up.

Transición epitelial-mesenquimal en la progresión del adenocarcinoma prostático / Epithelial-mesenquimal transition in the progression of prostatic adenocarcinoma / Transição epitélial-mesenquimal na progressão adenocarcinoma da próstata

Mundialmente, el adenocarcinoma prostático es el segundo cáncer diagnosticado en hombres y las metástasis son su principal complicación; se ha descrito la participación en su desarrollo de la transición epitelial-mesenquimal (TEM) proceso fundamental durante el desarrollo embrionario, la remodelación tisular y la cicatrización, que implica pérdida de las propiedades adhesivas y la polaridad epitelial y adquisición del fenotipo mesenquimal que aumenta la movilidad celular individual y permite el desarrollo de características invasivas. Este cambio en el comportamiento celular es mediado por una regulación molecular compleja en la que participa un gran número de vías de señalización, algunas actuando en forma independiente y otras interconectadas; la mayoría converge en el control de la expresión de la E-cadherina, cuya subregulación es el evento molecular clave en este proceso. Diversos estudios señalan una relación estrecha entre la TEM y el desarrollo y progresión de metástasis en carcinomas, pero ha sido menos ampliamente estudiada en el adenocarcinoma prostático. Los objetivos de esta revisión fueron: describir las bases moleculares y morfológicas de este proceso biológico y analizar la influencia de sus reguladores en la adquisición del fenotipo agresivo por las células tumorales, específicamente en lo que tiene que ver con la progresión del adenocarcinoma prostático.

Worldwide, prostate adenocarcinoma is the second most frequently diagnosed cancer in men, and metastases are its most serious complication. The participation in its development of the epithelial-mesenchymal transition (EMT) has been described, a fundamental process during embryonic development, tissue remodeling and wound healing, which involves loss of adhesive properties and epithelial polarity, and acquisition of a mesenchymal phenotype with increasing cellular motility and invasive capability. This change in cellular behavior is mediated by a complex molecular regulation that includes a high number of signalization pathways acting independently or interconnected, many of them converging in the control of E-cadherin expression, whose regulation is the central molecular event of this process. Different studies support a tight link between EMT and progression and metastases development of carcinomas, but it has been less extensively studied in prostate adenocarcinoma. The aim of this review was to describe the molecular and morphological bases of this biological process, and to analyze the participation of regulators in the acquisition of an aggressive phenotype by tumor cells, specifically in regards to prostate adenocarcinoma progression.

Mundialmente, o adenocarcinoma prostático é o segundo câncer diagnosticado em homens e as metástases são sua principal complicação; descreveu-se a participação em seu desenvolvimento da transição epitélio-mesenquimal (TEM) processo fundamental durante o desenvolvimento embrionário, a remodelação tissular e a cicatrização, que implica perda das propriedades adesivas e a polaridade epitelial e aquisição do fenótipo mesenquimal que aumenta a mobilidade celular individual e permite o desenvolvimento de características invasivas. Esta mudança no comportamento celular é mediado por uma regulação molecular complexa na que participa um grande número de vias de sinalização, algumas atuando em forma independente e outras interconectadas; a maioria converge no controle da expressão da Ecadherin, cuja sub-regulação é o evento molecular clave neste processo. Diversos estudos assinalam uma relação estreita entre a TEM e o desenvolvimento e progressão de metástase em carcinomas, mas foi menos amplamente estudada no adenocarcinoma descrever as bases moleculares e morfológicas deste processo biológico e analisar a influência de seus reguladores na aquisição do fenótipo agressivo pelas células tumorais, especificamente em relação com a progressão do adenocarcinoma prostático.

Expressions of TFF1 and TFF3 in prostate cancer and prostatic intraepithelial neoplasia and their clinical significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the expressions of trefoil factor 1 (TFF1) and trefoil factor 3 (TFF3) in prostate cancer (PCa) and prostate intraepithelial neoplasia (PIN) and their clinical significance.</p><p><b>METHODS</b>Using immunohistochemistry, we detected the expressions of TFF1 and TFF3 in the prostatic tissues of 89 cases of PCa, 50 cases of PIN, and 65 cases of benign prostate hyperplasia (BPH), and evaluated their clinical significance.</p><p><b>RESULTS</b>The positive rates of TFF1 and TFF3 expressions were 77. 53% and 48. 31% in PCa and 66.00% and 30.00% in PIN, significantly higher than 49.23% and 13. 85% in BPH (P <0. 05). The expression of TFF1 was not correlated with Gleason score (P >0. 05), while that of TFF3 was significantly higher in the PCa cases with Gleason score ≤7 than in those with Gleason score > 7 (70. 00% vs 42. 03%, P <0. 05). No significant correlation was observed between TFF1 and TFF3 expressions in PCa (P >0. 05).</p><p><b>CONCLUSION</b>The expressions of TFF1 and TFF3 may contribute to the occurrence and progression of PCa, and therefore could be used as laboratory indexes in the diagnosis, differential diagnosis, and prognosis of PCa.</p>

Expression of the epithelial cell adhesion molecule in prostate cancer and its clinical significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the expression of the epithelial cell adhesion molecule (EpCAM) in prostate cancer (PCa) and its clinical significance.</p><p><b>METHODS</b>We collected tissue samples from 63 cases of PCa, 46 cases of prostatic intraepithelial neoplasia (PIN), and 58 cases of benign prostatic hyperplasia (BPH) adjacent to PCa and determined the expression of EpCAM in the epithelial and stromal cells by immunohistochemistry.</p><p><b>RESULTS</b>The positive expression rates of EpCAM in the epithelial cells were significantly higher in PCa and PIN than in PCa-adjacent BPH (98. 4 and 97. 8 vs 51.7%, P <0. 01), and so was that in the stromal cells of PCa than in those of PCa-adjacent PIN (89.5 vs 50.0%, P <0.01). The expression of EpCAM.was remarkably higher in the stromal cells of bone metastasis than in those of non-bone metastasis tissue (100. 0 vs 40. 0%, P <0. 01) but showed no statistically significant differences between the highly and poorly differentiated PCa tissues (88.5 vs 91.9%, P >0.05).</p><p><b>CONCLUSION</b>The expression level of EpCAM in the stromal cells of PCa is related to the occurrence, progression, and bone metastasis of the tumor, and therefore may be used as a marker in the early diagnosis of PCa as well as a predictor of bone metastasis of the tumor.</p>

Clinical features and prognosis of prostate cancer with high-grade prostatic intraepithelial neoplasia

PURPOSE: To evaluate the clinical features and biochemical recurrence (BCR) in prostate cancer (PCa) with high-grade prostatic intraepithelial neoplasia (HGPIN). MATERIALS AND METHODS: We retrospectively analyzed the medical records of 893 patients who underwent a radical prostatectomy for PCa between 2011 and 2012 at Asan Medical Center; 752 of these patients who did not receive neoadjuvant or adjuvant therapy and were followed up for more than 1 year were included. The cohort was divided into two groups-patients with and without HGPIN-and their characteristics were compared. The Cox proportional hazards model was used to analyze factors affecting BCR. RESULTS: In total, 652 study patients (86.7%) had HGPIN. There were no significant differences in preoperative factors between the two groups, including age (p=0.369) and preoperative prostate-specific antigen concentration (p=0.234). Patients with HGPIN had a higher Gleason score (p=0.012), more frequent multiple tumor (p=0.013), and more perineural invasion (p=0.012), but no other postoperative pathologic characteristics were significantly different between the two groups. There were no significant differences in BCR (13.0% vs. 11.5%, p=0.665) and HGPIN was not associated with BCR (p=0.745). In multivariate analysis, only the T stage (p<0.001) was associated with BCR. CONCLUSIONS: PCa patients with HGPIN have a higher Gleason score, more frequent multiple tumors, and more perineural invasion than those without HGPIN. The presence of HGPIN is not an independent predictor of BCR.

Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy

PURPOSE: To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. MATERIALS AND METHODS: We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. RESULTS: A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). CONCLUSIONS: Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients.

How many cores should be taken in a repeat biopsy on patients in whom atypical small acinar proliferation has been identified in an initial transrectal prostate biopsy?

Objective To compare cancer detection rates according to the number of biopsy cores in patients on whom a repeat prostate biopsy was performed for atypical small acinar proliferation (ASAP). Materials and Methods The data of 4950 consecutive patients on whom prostate biopsies were performed were assessed retrospectively. A total of 107 patients were identified as having ASAP following an initial prostate biopsy, and they were included in the study. A six-core prostate biopsy (PBx) was performed on 15 of the 107 patients, 12 PBx on 32 patients, and 20 PBx on 60 patients. Cancer detection rates were compared according to the number of biopsy cores. The localization of the cancer foci was also evaluated. Results The cancer detection rates in patients on whom 6 PBx, 12 PBx, and 20 PBx were performed were 20% (3/15), 31% (10/32), and 58% (35/60), respectively, and a statistically significant difference was found (p = 0.005). When cancer detection rates in patients with total prostate specific antigen (PSA) < 10ng/mL, PSA density ≥ 0.15, normal digital rectal examination, and prostate volume ≥ 55mL were compared according to the number of biopsy cores, a significant difference was identified (p = 0.02, 0.03, 0.006, and 0.04, respectively). Seventy-five percent of the foci where cancer was detected were at the same and/or adjacent sites as the ASAP foci in the initial biopsy, and 54% were identified in contralateral biopsies in which ASAP foci were present. Conclusion As the biopsy core number increases, the cancer detection rate increases significantly in patients on whom a repeat biopsy is performed due to ASAP. The highest cancer rate is found in 20-core repeat biopsies performed equally from all foci. .

What Is the Ideal Core Number for Ultrasound-Guided Prostate Biopsy?

PURPOSE: We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). MATERIALS AND METHODS: A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens. RESULTS: No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found. CONCLUSIONS: Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy.

Intraductal Carcinoma of Prostate: A Comprehensive and Concise Review

Intraductal carcinoma of the prostate (IDC-P) is defined as a proliferation of prostate adenocarcinoma cells distending and spanning the lumen of pre-existing benign prostatic ducts and acini, with at least focal preservation of basal cells. Studies demonstrate that IDC-P is strongly associated with high-grade (Gleason grades 4/5), large-volume invasive prostate cancers. In addition, recent genetic studies indicate that IDC-P represents intraductal spread of invasive carcinoma, rather than a precursor lesion. Some of the architectural patterns in IDC-P exhibit architectural overlap with one of the main differential diagnoses, high-grade prostatic intraepithelial neoplasia (HGPIN). In these instances, additional diagnostic criteria for IDC-P, including marked nuclear pleomorphism, non-focal comedonecrosis (>1 duct showing comedonecrosis), markedly distended normal ducts/acini, positive nuclear staining for ERG, and cytoplasmic loss of PTEN by immunohistochemistry, can help make the distinction. This distinction between IDC-P and HGPIN is of critical importance because IDC-P has an almost constant association with invasive carcinoma and has negative clinical implications, including shorter relapse-free survival, early biochemical relapse, and metastatic failure rate after radiotherapy. Therefore, IDC-P should be reported in prostate biopsies and radical prostatectomies, regardless of the presence of an invasive component. This article will review the history, diagnostic criteria, molecular genetics, and clinical significance of IDC-P.

High-Grade Prostatic Intraepithelial Neoplasia

High-grade prostatic intraepithelial neoplasia (HGPIN) has been established as a precursor to prostatic adenocarcinoma. HGPIN shares many morphological, genetic, and molecular signatures with prostate cancer. Its predictive value for the development of future adenocarcinoma during the prostate-specific antigen screening era has decreased, mostly owing to the increase in prostate biopsy cores. Nevertheless, a literature review supports that large-volume HGPIN and multiple cores of involvement at the initial biopsy should prompt a repeat biopsy of the prostate within 1 year. No treatment is recommended for HGPIN to slow its progression to cancer.