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Ozkaya M, Simsekoglu MF, Kalender G, Sahin KC, Gurses I. Clinical and histopathological parameters in transrectal ultrasound-guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups. Prostate 2024. [PMID: 38798171 DOI: 10.1002/pros.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Thanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low-intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and underwent Rp. METHODS A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS-Bx without metastasis and who underwent Rp were grouped according to the D'Amico risk classification. Age at diagnosis, serum prostate-specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) score, clinical stage, Gleason Grade Group (GGG), high-grade intraepithelial neoplasia in tumor-free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI on TRUS-Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately. RESULTS Of the patients, 72 (35.1%) were in the low-risk group, 95 (46.3%) in the intermediate-risk group, and 38 (18.5%) in the high-risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low-risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor-free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029-1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006-1.090, p < 0.05), HGPIN in ≥2 tumor-free cores (OR: 6.346, 95% CI: 3.136-12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179-8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low-risk group was an independent risk factor when compared to the intermediate- and high-risk groups (OR: 0.187, 95% CI: 0.080-0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013-0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low- and intermediate-risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS-Bx. High serum PSA and PSA density values were associated with LVI on TRUS-Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS-Bx. HGPIN in ≥2 tumor-free cores, PNI, and LVI on TRUS-Bx were associated with a higher rate of lymph node metastases. CONCLUSIONS In patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor-free core on TRUS-Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor-free cores on TRUS-Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low-risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor-free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.
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Affiliation(s)
- Mustafa Ozkaya
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Muhammed Fatih Simsekoglu
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Goktug Kalender
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kadir Can Sahin
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Iclal Gurses
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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2
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Talwar R, Akinsola O, Penson DF. What is cancer? A focus on Grade Group 1 prostate cancer. BJU Int 2024; 133:360-364. [PMID: 38229478 DOI: 10.1111/bju.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Since the widespread adoption of prostate-specific antigen-based screening for prostate cancer, the prevalence of Grade Group 1 (GG1) prostate cancer has risen. Historically, these patients were subjected to overtreatment of this otherwise indolent disease process, leading to significant quality-of-life detriments. Active surveillance as a primary management strategy has allowed for a focus on early detection while minimising morbidity from unnecessary intervention. Here we provide a comprehensive overview of the characteristics of GG1 prostatic adenocarcinoma, including its histological features, genomic differentiators, clinical progression, and implications for treatment guidelines, all supporting the movement to reclassify GG1 disease as a non-cancerous entity.
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Affiliation(s)
- Ruchika Talwar
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David F Penson
- Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Advances in Molecular Regulation of Prostate Cancer Cells by Top Natural Products of Malaysia. Curr Issues Mol Biol 2023; 45:1536-1567. [PMID: 36826044 PMCID: PMC9954984 DOI: 10.3390/cimb45020099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Prostate cancer (PCa) remains both a global health burden and a scientific challenge. We present a review of the molecular targets driving current drug discovery to fight this disease. Moreover, the preventable nature of most PCa cases represents an opportunity for phytochemicals as chemopreventive when adequately integrated into nutritional interventions. With a renovated interest in natural remedies as a commodity and their essential role in cancer drug discovery, Malaysia is looking towards capitalizing on its mega biodiversity, which includes the oldest rainforest in the world and an estimated 1200 medicinal plants. We here explore whether the list of top Malay plants prioritized by the Malaysian government may fulfill the potential of becoming newer, sustainable sources of prostate cancer chemotherapy. These include Andrographis paniculate, Centella asiatica, Clinacanthus nutans, Eurycoma longifolia, Ficus deltoidea, Hibiscus sabdariffa, Marantodes pumilum (syn. Labisia pumila), Morinda citrifolia, Orthosiphon aristatus, and Phyllanthus niruri. Our review highlights the importance of resistance factors such as Smac/DIABLO in cancer progression, the role of the CXCL12/CXCR4 axis in cancer metastasis, and the regulation of PCa cells by some promising terpenes (andrographolide, Asiatic acid, rosmarinic acid), flavonoids (isovitexin, gossypin, sinensetin), and alkylresorcinols (labisiaquinones) among others.
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4
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Which men with non-malignant pathology at magnetic resonance imaging-targeted prostate biopsy and persistent PI-RADS 3-5 lesions should repeat biopsy? Urol Oncol 2022; 40:452.e9-452.e16. [DOI: 10.1016/j.urolonc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
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5
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Coradduzza D, Solinas T, Azara E, Culeddu N, Cruciani S, Zinellu A, Medici S, Maioli M, Madonia M, Carru C. Plasma Polyamine Biomarker Panels: Agmatine in Support of Prostate Cancer Diagnosis. Biomolecules 2022; 12:biom12040514. [PMID: 35454104 PMCID: PMC9024899 DOI: 10.3390/biom12040514] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/10/2022] [Accepted: 03/26/2022] [Indexed: 01/03/2023] Open
Abstract
Prostate cancer is the most frequent malignant tumour among males (19%), often clinically silent and of difficult prognosis. Although several studies have highlighted the diagnostic and prognostic role of circulating biomarkers, such as PSA, their measurement does not necessarily allow the detection of the disease. Within this context, many authors suggest that the evaluation of circulating polyamines could represent a valuable tool, although several analytical problems still counteract their clinical practice. In particular, agmatine seems particularly intriguing, being a potential inhibitor of polyamines commonly derived from arginine. The aim of the present work was to evaluate the potential role of agmatine as a suitable biomarker for the identification of different classes of patients with prostate cancer (PC). For this reason, three groups of human patients—benign prostatic hyperplasia (BPH), precancerous lesion (PL), and prostate cancer (PC)—were recruited from a cohort of patients with suspected prostate cancer (n = 170), and obtained plasma was tested using the LC-HRMS method. Statistics on the receiver operating characteristics curve (ROC), and multivariate analysis were used to examine the predictive value of markers for discrimination among the three patient groups. Statistical analysis models revealed good discrimination using polyamine levels to distinguish the three classes of patients. AUC above 0.8, sensitivity ranging from 67% to 89%, specificity ranging from 74% to 89% and accuracy from 73% to 86%, considering the validation set, were achieved. Agmatine plasma levels were measured in PC (39.9 ± 12.06 ng/mL), BPH (77.62 ± 15.05 ng/mL), and PL (53.31 ± 15.27 ng/mL) patients. ROC analysis of the agmatine panel showed an AUC of 0.959 and p ≤ 0.001. These results could represent a future tool able to discriminate patients belonging to the three different clinical groups.
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Affiliation(s)
- Donatella Coradduzza
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (D.C.); (S.C.); (A.Z.); (M.M.)
| | - Tatiana Solinas
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, 07100 Sassari, Italy; (T.S.); (M.M.)
| | - Emanuela Azara
- Institute of Biomolecular Chemistry, National Research Council, 07100 Sassari, Italy; (E.A.); (N.C.)
| | - Nicola Culeddu
- Institute of Biomolecular Chemistry, National Research Council, 07100 Sassari, Italy; (E.A.); (N.C.)
| | - Sara Cruciani
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (D.C.); (S.C.); (A.Z.); (M.M.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (D.C.); (S.C.); (A.Z.); (M.M.)
| | - Serenella Medici
- Department of Chemistry and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (D.C.); (S.C.); (A.Z.); (M.M.)
| | - Massimo Madonia
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, 07100 Sassari, Italy; (T.S.); (M.M.)
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (D.C.); (S.C.); (A.Z.); (M.M.)
- Department of Biomedical Sciences and University Hospital of Sassari (AOU), 07100 Sassari, Italy
- Correspondence:
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Surintrspanont J, Zhou M. Prostate Pathology: What is New in the 2022 WHO Classification of Urinary and Male Genital Tumors? Pathologica 2022; 115:41-56. [PMID: 36645399 DOI: 10.32074/1591-951x-822] [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: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023] Open
Abstract
In 2022, after a six-year interval, the International Agency for Research on Cancer (IARC) has published the 5th edition of the WHO Classification of Urinary and Male Genital Tumors, which provides a comprehensive update on tumor classification of the genitourinary system. This review article focuses on prostate carcinoma and underscores changes in the prostate chapter as well as those made across the entire series of the 5th edition of WHO Blue Books. Although no major alterations were made to this chapter, some of the most notable updates include restructure of contents and introduction of a new format; standardization of mitotic counts, genomic nomenclatures, and units of length; refined definition for the terms "variant", "subtype", and "histologic pattern"; reclassification of prostatic intraepithelial neoplasia (PIN)-like adenocarcinoma as a subtype of prostatic acinar adenocarcinoma; and recognition of treatment-related neuroendocrine prostatic carcinoma as a distinct tumor type. Evolving and unsettled issues related to grading of intraductal carcinoma of the prostate and reporting of tertiary Gleason pattern, the definition and prognostic significance of cribriform growth pattern, and molecular pathology of prostate cancer will also be covered in this review.
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Affiliation(s)
- Jerasit Surintrspanont
- Department of Pathology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Ming Zhou
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
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7
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Implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy: a 5-year follow-up study. Ir J Med Sci 2021; 191:2035-2040. [PMID: 34799794 DOI: 10.1007/s11845-021-02854-2] [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: 07/27/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the era of active surveillance of low- and intermediate-risk prostatic cancer, a reconsideration of the implications of a biopsy report of ASAP and/or HGPIN may be timely. AIMS We investigated the implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy. METHODS The rate of re-biopsy and the incidence of carcinoma on repeat biopsy for benign, HGPIN, and ASAP groups were compared. Mean PSA and PSA velocity was also compared between groups. RESULTS There was an increased risk of developing prostate cancer in the following 5 years with a biopsy diagnosis of ASAP compared to benign (20% vs 5.9%, p = 0.009), and with a biopsy of HGPIN compared with benign (14.8% vs 5.9%, p = 0.005). The frequency of repeat biopsy following a diagnosis of ASAP (54.2%) vs. HGPIN (37%) was not significantly different (p = 0.079). The risk of developing prostate cancer was highest following a biopsy with concomitant ASAP and HGPIN compared to benign (50% vs 5.9%, p < 0.001). There was no significant difference in PSA values between the 3 diagnostic groups at the time of initial biopsy (p = 0.206). CONCLUSION The findings of this study suggest that a biopsy diagnosis of ASAP ± HGPIN, on either initial or surveillance biopsy, provides support for earlier repeat mpMRI and/or re-biopsy. This may assist in directing to early re-biopsy those patients likely to have intermediate- and high-risk prostate cancer.
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8
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Morote J, Schwartzmann I, Celma A, Roche S, de Torres IM, Mast R, Semidey ME, Regis L, Santamaria A, Planas J, Trilla E. The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia. BJU Int 2021; 129:627-633. [PMID: 34375498 DOI: 10.1111/bju.15568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/15/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies. PATIENTS AND METHODS A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and who underwent repeat biopsy within 1 to 3 years, was analysed. Pre-repeat biopsy mpMRI and guided biopsies to suspicious lesions (Prostate Imaging - Reporting and Data System [PI-RADS] ≥3) and/or and systematic biopsies were performed. Persistent prostate cancer (PCa) suspicion, defined as sustained serum prostate-specific antigen level >4 ng/mL and/or abnormal digital rectal examination, was present in 248 men (84.6%), and was absent in 45 men (15.4%). A control group of 190 men who had no previous HGPIN, atypical small acinar proliferation or HGPIN with atypia who were scheduled to undergo repeat biopsy due to persistent PCa suspicion were also analysed. csPCa was defined as tumours of Grade Group ≥2. RESULTS In the subset of 45 men with isolated HGPIN, in whom PCa suspicion disappeared, only one csPCa (2.2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34.7% of men with persistent PCa suspicion and previous HGPIN, and in 28.4% of those without previous HGPIN (P =0.180). iPCa was detected in 12.1% and 6.3%, respectively (P =0.039). Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN: odds ratio (OR) 1.369 (95% confidence interval [CI] 0.894-2.095; P =0.149); however, previous HGPIN increased the risk of iPCa detection: OR 2.043 (95% CI 1.016-4.109; P =0.006). CONCLUSION The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Anna Celma
- Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Sarai Roche
- Department of Radiology, Vall d´Hebron Hospital, Barcelona, Spain
| | - Inés M de Torres
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Pathology, Vall d´Hebron Hospital, Barcelona, Spain
| | - Richard Mast
- Department of Radiology, Vall d´Hebron Hospital, Barcelona, Spain
| | - Maria E Semidey
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Department of Pathology, Vall d´Hebron Hospital, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Anna Santamaria
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d´Hebron Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Oncogenic gene fusions in nonneoplastic precursors as evidence that bacterial infection can initiate prostate cancer. Proc Natl Acad Sci U S A 2021; 118:2018976118. [PMID: 34341114 DOI: 10.1073/pnas.2018976118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Prostate adenocarcinoma is the second most commonly diagnosed cancer in men worldwide, and the initiating factors are unknown. Oncogenic TMPRSS2:ERG (ERG+) gene fusions are facilitated by DNA breaks and occur in up to 50% of prostate cancers. Infection-driven inflammation is implicated in the formation of ERG+ fusions, and we hypothesized that these fusions initiate in early inflammation-associated prostate cancer precursor lesions, such as proliferative inflammatory atrophy (PIA), prior to cancer development. We investigated whether bacterial prostatitis is associated with ERG+ precancerous lesions in unique cases with active bacterial infections at the time of radical prostatectomy. We identified a high frequency of ERG+ non-neoplastic-appearing glands in these cases, including ERG+ PIA transitioning to early invasive cancer. These lesions were positive for ERG protein by immunohistochemistry and ERG messenger RNA by in situ hybridization. We additionally verified TMPRSS2:ERG genomic rearrangements in precursor lesions using tricolor fluorescence in situ hybridization. Identification of rearrangement patterns combined with whole-prostate mapping in three dimensions confirmed multiple (up to eight) distinct ERG+ precancerous lesions in infected cases. We further identified the pathogen-derived genotoxin colibactin as a potential source of DNA breaks in clinical cases as well as cultured prostate cells. Overall, we provide evidence that bacterial infections can initiate driver gene alterations in prostate cancer. In addition, our observations indicate that infection-induced ERG+ fusions are an early alteration in the carcinogenic process and that PIA may serve as a direct precursor to prostate cancer.
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10
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Schwartzmann I, Celma A, Regis L, Planas J, Roche S, de Torres IM, Semidey ME, Morote J. The current value of histological findings in negative prostate biopsies to predict the future risk of clinically significant prostate cancer. Actas Urol Esp 2021; 45:447-454. [PMID: 34140257 DOI: 10.1016/j.acuroe.2020.09.008] [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: 06/07/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Repeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP); extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN); or HGPIN with atypical glands; suspicious for adenocarcinoma (PIN-ATYP). Nowadays; multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP; mHGPIN; PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk. METHODS Retrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score >3 and 12-core transrectal ultrasound (TRUS) systematic PBx when ≤2. ASAP; HGPIN; mHGPIN; PIN-ATYP; and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade >2. RESULTS Incidence of ASAP; multifocal HGPIN (mHGPIN) and PINATYP was 4.2%; 39.7% and 3.7% respectively; and csPCa rate was statistically similar among men with these histological findings. However; the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present; and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa; with an OR of 0.54 (95%CI: 0.308-0.945; P = .031). In addition; PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of 0.86 (95%CI: 0.83-0.90). CONCLUSION PIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.
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Affiliation(s)
- I Schwartzmann
- Departamento de Urología y Trasplante Renal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - A Celma
- Departamento de Urología y Trasplante Renal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Regis
- Departamento de Urología y Trasplante Renal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Planas
- Departamento de Urología y Trasplante Renal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - S Roche
- Departamento de Radiología, Hospital Universitario Vall d'Hebrón, Univerisad Autónoma de Barcelona, Barcelona, Spain
| | - I M de Torres
- Departamento de Patología, Hospital Universitario Vall d'Hebrón Universidad Autónoma de Barcelona, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M E Semidey
- Departamento de Patología, Hospital Universitario Vall d'Hebrón Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Morote
- Departamento de Urología y Trasplante Renal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
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11
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The current value of histological findings in negative prostate biopsies to predict the future risk of clinically significant prostate cancer. Actas Urol Esp 2021. [PMID: 33958217 DOI: 10.1016/j.acuro.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Repeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP), extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN), or HGPIN with atypical glands, suspicious for adenocarcinoma (PIN-ATYP). Nowadays, multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP, mHGPIN, PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk. METHODS Retrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score>3 and 12-core transrectal ultrasound (TRUS) systematic PBx when≤2. ASAP, HGPIN, mHGPIN, PIN-ATYP, and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade>2. RESULTS Incidence of ASAP, multifocal HGPIN (mHGPIN) and PINATYP was 4.2%, 39.7% and 3.7% respectively, and csPCa rate was statistically similar among men with these histological findings. However, the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present, and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa, with an OR of .54 (95% CI: .308-.945, P=.031). In addition, PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of .86 (95% CI: .83-.90). CONCLUSIONS PIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.
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Totaro A, Di Gianfrancesco L, Pinto F, Racioppi M, Palermo G, Campetella M, Santoro AA, Arbia G, Sacco E. Rate of clinically significant prostate cancer on repeat saturation biopsy after a diagnosis of atypical small acinar proliferation. Urologia 2021; 88:194-199. [PMID: 33579180 DOI: 10.1177/0391560321993595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30%-40% of these patients may develop prostate cancer (PCa) within a 5-year period, often not clinically significant. Current guidelines recommend a repeat biopsy within 3-6 months after the initial diagnosis, but it seem not to be the best strategy. METHODS Objectives-evaluating the natural history of ASAP, stratifying the risk of csPCa after ASAP, identifying predictive factors of PCa after atypical diagnosis. Materials and methods-retrospective single-institutional study on patients undergoing prostate biopsy for suspicious PCa (2005-2016). We evaluated the incidence of overall PCa, intermediate-high risk of PCa and csPCa in case of ASAP, according to D'Amico classification and Epstein modified criteria. RESULTS Out of 4.567 patients undergoing prostate biopsy, ASAP was detected in 2.6% of cases. All patients with ASAP underwent repeat saturation biopsy within 6 months and PCa was diagnosed in 34.5%. According to D'Amico classification, 26%, 5.9%, and 2.5% had low, intermediate, and high-risk disease, respectively. According modified Epstein criteria, the incidence of csPCa was 12.6%. LRT showed that the overall probability to develop PCa doubled when PSA density (PSAD) moved from values lower than 0.13 ng/ml/cc to class 0.13-0.30 ng/ml/cc, and it tripled when PSAD was higher than 0.30 ng/ml/cc. CONCLUSIONS The rate of csPCa in patients with an initial diagnosis of ASAP who had repeat biopsy was 12.6%. The overall PCa rate was 34.5%. Among patient undergoing RP, an upgrading from ncsPCa to csPCa was reported in 35% of cases. PSAD is the only predictive factor directly associated to the risk of developing PCa on repeat biopsy. These findings suggest that immediate repeat biopsy remains the correct strategy in absence of novel predictor factors and non-invasive diagnostic evaluations.
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Affiliation(s)
- Angelo Totaro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Francesco Pinto
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Campetella
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Agostino Antonio Santoro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Arbia
- Department of Statistical Science, Faculty of Economics, Catholic University of the Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
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13
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Andras I, Telecan T, Crisan D, Cata E, Kadula P, Andras D, Bungardean M, Coman I, Crisan N. Different clinical significance of ASAP/HGPIN pattern in systematic vs. MRI-US fusion guided prostate biopsy. Exp Ther Med 2020; 20:195. [PMID: 33123225 DOI: 10.3892/etm.2020.9325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Atypical small acinar proliferation (ASAP) and high grade intraepithelial neoplasia (HGPIN) patterns identified at prostate biopsy yield an important clinical significance, their presence signaling an increased likelihood of future oncological development or underdiagnosed PCa. MRI and MRI-TRUS fusion prostate biopsy have recently become the standard for the diagnosis of prostate cancer. Thus, we aimed to assess the role of ASAP/HGPIN pattern in the context of these recent developments as compared with the standard systematic biopsy. The present study included 400 patients who underwent MRI-TRUS fusion prostate biopsy. A subgroup of these patients had a history of prior systematic biopsy and their results were also included in the analysis. We observed that ASAP/HGPIN pattern diagnosed at systematic biopsy is suggestive of a high-volume clinically-significant disease, most probably located outside the standard sampling area. On the contrary, ASAP/HGPIN at MRI-TRUS fusion biopsy has clinical features more similar to benign prostate hyperplasia, thus suggesting a more incipient disease, if present. No relation between concurrent ASAP/HGPIN and PCa was observed in our study.
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Affiliation(s)
- Iulia Andras
- Urology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Teodora Telecan
- Urology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dana Crisan
- Internal Medicine Department, 5th Medical Clinic, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Emanuel Cata
- Urology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Pierre Kadula
- Urology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - David Andras
- General Surgery Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Maria Bungardean
- Pathology Department, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
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14
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Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9872146. [PMID: 32775459 PMCID: PMC7396080 DOI: 10.1155/2020/9872146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
Background To evaluate the diagnostic potential of [-2] proPSA (p2PSA), %p2PSA, Prostate Health Index (phi), and phi density (PHID) as independent biomarkers and in composition of multivariable models in predicting high-grade prostatic intraepithelial neoplasia (HGPIN) and overall and clinically significant prostate cancer (PCa). Methods 210 males scheduled for prostate biopsy with total PSA (tPSA) range 2-10 ng/mL and normal digital rectal examination were enrolled in the prospective study. Blood samples to measure tPSA, free PSA (fPSA), and p2PSA were collected immediately before 12-core prostate biopsy. Clinically significant PCa definition was based on Epstein's criteria or ISUP grade ≥ 2 at biopsy. Results PCa has been diagnosed in 112 (53.3%) patients. Epstein significant and ISUP grade ≥ 2 PCa have been identified in 81 (72.3%) and 40 (35.7%) patients, respectively. Isolated HGPIN at biopsy have been identified in 24 (11.4%) patients. Higher p2PSA and its derivative mean values were associated with PCa. At 90% sensitivity, PHID with cut-off value of 0.54 have demonstrated the highest sensitivity of 35.7% for overall PCa detection, so PHID and phi with cut-off values of 33.2 and 0.63 have demonstrated the specificity of 34.7% and 34.1% for ISUP grade ≥ 2 PCa detection at biopsy, respectively. In univariate ROC analysis, PHID with AUC of 0.77 and 0.80 was the most accurate predictor of overall and Epstein significant PCa, respectively, so phi with AUC of 0.77 was the most accurate predictor of ISUP grade ≥ 2 PCa at biopsy. In multivariate logistic regression analysis, phi improved diagnostic accuracy of multivariable models by 5% in predicting ISUP grade ≥ 2 PCa. Conclusions PHID and phi have shown the greatest specificity at 90% sensitivity in predicting overall and clinically significant PCa and would lead to significantly avoid unnecessary biopsies. PHID is the most accurate predictor of overall and Epstein significant PCa, so phi is the most accurate predictor of ISUP grade ≥ 2 PCa. phi significantly improves the diagnostic accuracy of multivariable models in predicting ISUP grade ≥ 2 PCa.
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15
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Hasan IA, Gaidan HA, Al-Kaabi MM. Diagnostic Value of Cytokeratin 34 beta E12 (Ck34βE12) and α-Methylacyl-CoA racemase (AMACR) Immunohistochemical Expression in Prostatic Lesions. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:232-238. [PMID: 32754219 PMCID: PMC7354068 DOI: 10.30699/ijp.2020.113544.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
Background & Objective Some prostatic lesions contain small suspicious foci for prostatic carcinoma in which the morphological features are equivocal. Two immunohistochemical markers namely, cytokeratin 34 beta E12 (Ck34βE12) and α-Methylacyl-CoA racemase (AMACR), were evaluated in these lesions for a definitive diagnosis and avoiding misdiagnosis or overdiagnosis of prostatic carcinoma. Methods A total of 90 paraffin embedded blocks of prostatic tissue were selected and categorized into three groups as follows: 50 cases of benign prostatic hyperplasia (BPH), 20 cases of prostatic carcinoma, and 20 cases of benign prostatic lesions with suspicious foci labeled as ASAP (atypical small acinar proliferation) that occupy not more than 5% of the lesion. These cases were revised for histopathological diagnosis and stained with two immunohistochemical markers: Ck34βE12 and AMACR. Results While 92.9% of BPH were positive for Ck34βE12, 96% of prostatic carcinoma were negative for this marker (P=0.0001). Regarding AMACR, 92.9% of BPH cases were negative, but 92% of prostatic carcinoma cases were positive for this marker (P=0.0001). Out of 20 cases of BPH, 15 cases containing suspicious foci showed Ck34βE12+/AMACR- (diagnosis: benign), but 5 cases were Ck34βE12-/AMACR+, for which the diagnosis changed to prostatic carcinoma (P=0.04). Conclusion Immunohistochemical staining with Ck34βE12 and AMACR improved the diagnostic performance and increased confidence level for establishing definite diagnosis in cases with suspicious foci, in which the morphological features were equivocal. This could help to avoid misdiagnosis or overdiagnosis of prostatic carcinoma that would eventually improve the management of the patient and subsequently the prognosis.
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Affiliation(s)
- Ikram A Hasan
- Pathology and Forensic Medicine Department, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Hiba Ahmed Gaidan
- Pathology and Forensic Medicine Department, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Methaq Mueen Al-Kaabi
- Pathology and Forensic Medicine Department, College of Medicine, Mustansiriyah University, Baghdad, Iraq
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16
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Azal Neto W, Andrade GM, Billis A, Reis LO. Biopsy core length in white versus African descendant prostate cancer patients. Scand J Urol 2020; 54:188-193. [PMID: 32343184 DOI: 10.1080/21681805.2020.1754907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore whether distinct prostate cancer (PCa) prognoses between ethnicities could be explained by diverse characteristics in the prostate biopsy.Methods: Clinical, prostate biopsy and surgical single-institution data of whites and African descendants with similar access to the health system who underwent radical prostatectomy whole gland histopathology within 60 days after biopsy from 2010 to 2011 and followed for 5 years minimum were compared.Results: Among 203 included patients, 153 (75.4%) were whites and 50 (24.6%) were African descendants. The mean patients' age was 63.7 (± 6.8) years. Digital rectal examination (DRE) was suspected of cancer in 45.2% of the patients. The prostate biopsy core length was smaller in African descendants than in whites, overall 11.0 ± 3.2 vs 12.0 ± 2.9 mm, p = 0.037, and without neoplasia, 10.4 ± 3.8 vs 11.7 ± 3.1 mm, p = 0.038, respectively. Also, suspicious DRE showed smaller biopsy core length, overall 11.1 ± 3.2 mm vs 12.4 ± 2.6, p = 0.003, cancer positive 12.0 ± 4.8 mm vs 13.3 ± 3.7, p = 0.022 and negative 10.6 ± 3.6 mm vs 12.2 ± 3.0, p = 0.002. On 81 months median follow-up, more African descendants were lost to follow-up (10%, n = 5 vs 3.9%, n = 6) and the biochemical recurrence rate was the same between the groups (33.3%).Conclusion: In a PCa population with similar access to the health system, prostate biopsy core length in African descendant men is significantly smaller than in whites. This finding is new and may add to the controversial argument of PCa having a worse prognosis in African descendant patients.
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Affiliation(s)
- Wilmar Azal Neto
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Guilherme Miranda Andrade
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Athanase Billis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Leonardo O Reis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
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17
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Kumar NB, Pow-Sang J, Spiess P, Dickinson S, Schell MJ. A phase II randomized clinical trial using aglycone isoflavones to treat patients with localized prostate cancer in the pre-surgical period prior to radical prostatectomy. Oncotarget 2020; 11:1218-1234. [PMID: 32292572 PMCID: PMC7147089 DOI: 10.18632/oncotarget.27529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/03/2020] [Indexed: 01/11/2023] Open
Abstract
Prostate cancer (PCa) is the most common cancer in American men. Additionally, African American Men (AAM) are 60% more likely to be diagnosed with PCa and 2.4 times more likely to die from this disease compared to Caucasian men (CM). To date, there are few strategies effective for chemoprevention for men with localized PCa. There is thus a need to continue to evaluate agents and strategies for chemoprevention of prostate cancer. Epidemiological, laboratory and early phase clinical trials have shown that the isoflavones modulates several biomarkers implicated in prostate carcinogenesis. The goal of this phase II randomized clinical trial was to explore the comparative effectiveness and safety of 40 mgs of aglycone isoflavones in AAM and CM with localized PCa in the pre-surgical period prior to radical prostatectomy. Thirty six participants (25 CM, 6AAM) were randomized to the isoflavone arm and 34 (25 CM, 7AAM) to the placebo arm, with 62 completing the intervention. Results indicated that isoflavones at a dose of 20 mgs BID for 3-6 weeks was well tolerated but did not reduce tissue markers of proliferation. A significant reduction in serum PSA was observed with isoflavone supplementation in CM compared to the placebo arm, but not observed in AAM. We observed no changes in serum steroid hormones with isoflavone supplementation. In AAM, a reduction in serum IGF-1 concentrations and IGF1: IGFBP-3 ratios were observed with isoflavone supplementation. Well-powered studies for longer duration of intervention may inform future trials with isoflavones, for chemoprevention of PCa.
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Affiliation(s)
- Nagi B Kumar
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Inc., Tampa, FL, USA
| | - Julio Pow-Sang
- Department of Urology, H. Lee Moffitt Cancer Center and Research Institute, Inc., Tampa, FL, USA
| | - Philippe Spiess
- Department of Urology, H. Lee Moffitt Cancer Center and Research Institute, Inc., Tampa, FL, USA
| | - Shohreh Dickinson
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Inc., Tampa, FL, USA
| | - Michael J Schell
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Inc., Tampa, FL, USA
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18
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Aldaoud N, Hallak A, Abdo N, Al Bashir S, Marji N, Graboski-Bauer A. Interobserver Variability in the Diagnosis of High-Grade Prostatic Intraepithelial Neoplasia in a Tertiary Hospital in Northern Jordan. CLINICAL PATHOLOGY 2020; 13:2632010X19898472. [PMID: 31950103 PMCID: PMC6952849 DOI: 10.1177/2632010x19898472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
Abstract
Prostate intraepithelial neoplasia is described as a precursor lesion to prostatic adenocarcinoma. High-grade prostate intraepithelial neoplasia (HGPIN) is classified as both grade 2 and 3 prostate intraepithelial neoplasia due to inconsistency between pathologists' findings. In our study, we assessed the interobserver variability in the diagnosis of HGPIN among genitourinary and nongenitourinary pathologists. All cases with prostate adenocarcinoma diagnosis on needle core biopsy, radical prostatectomy, and transurethral resection of prostate (TURP) between the years 2005 and 2014 were included. In total, 191 prostate cancer cases were included: 109 needle core biopsies, 45 radical prostatectomies, and 37 TURP. All were independently reviewed by 2 urologic pathologists for the presence of HGPIN. High-grade prostate intraepithelial neoplasia was diagnosed in 65 cases (34%), among which the lesion was recognized by the reporting pathologists in 36 (55%) of the cases and was missed in 29 (45%) of the cases with a κ coefficient of 0.53. There was a moderate interobserver agreement in the diagnosis of HGPIN. Consultation with genitourinary pathologist can improve HGPIN diagnosis.
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Affiliation(s)
- Najla Aldaoud
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan.,Department of Pathology and Microbiology, King Abdullah University Hospital, Irbid, Jordan
| | - Amer Hallak
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour Abdo
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Samir Al Bashir
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Noor Marji
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan.,Department of Pathology, University of Florida, Jacksonville, FL, USA
| | - Ashley Graboski-Bauer
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
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19
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Ahmed M, Goh C, Saunders E, Cieza-Borrella C, Kote-Jarai Z, Schumacher FR, Eeles R. Germline genetic variation in prostate susceptibility does not predict outcomes in the chemoprevention trials PCPT and SELECT. Prostate Cancer Prostatic Dis 2019; 23:333-342. [PMID: 31776447 PMCID: PMC7237354 DOI: 10.1038/s41391-019-0181-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
Background The development of prostate cancer can be influenced by genetic and environmental factors. Numerous germline SNPs influence prostate cancer susceptibility. The functional pathways in which these SNPs increase prostate cancer susceptibility are unknown. Finasteride is currently not being used routinely as a chemoprevention agent but the long term outcomes of the PCPT trial are awaited. The outcomes of the SELECT trial have not recommended the use of chemoprevention in preventing prostate cancer. This study investigated whether germline risk SNPs could be used to predict outcomes in the PCPT and SELECT trial. Methods Genotyping was performed in European men entered into the PCPT trial (n = 2434) and SELECT (n = 4885). Next generation genotyping was performed using Affymetrix® Eureka™ Genotyping protocols. Logistic regression models were used to test the association of risk scores and the outcomes in the PCPT and SELECT trials. Results Of the 100 SNPs, 98 designed successfully and genotyping was validated for samples genotyped on other platforms. A number of SNPs predicted for aggressive disease in both trials. Men with a higher polygenic score are more likely to develop prostate cancer in both trials, but the score did not predict for other outcomes in the trial. Conclusion Men with a higher polygenic risk score are more likely to develop prostate cancer. There were no interactions of these germline risk SNPs and the chemoprevention agents in the SELECT and PCPT trials.
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Affiliation(s)
- Mahbubl Ahmed
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Chee Goh
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Edward Saunders
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Clara Cieza-Borrella
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK
| | | | - Zsofia Kote-Jarai
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Fredrick R Schumacher
- Department of Epidemiology and Biostatistics, Case Western Reserve University; Seidman Cancer Center, University Hospitals, Cleveland, OH, USA
| | - Ros Eeles
- The Institute of Cancer Research, Royal Marsden Hospital, NHS Foundation Trust, 123 Old Brompton Road, London, SW7 3RP, UK
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20
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Ha H, Chung JW, Ha YS, Choi SH, Lee JN, Kim BS, Kim HT, Kim TH, Yoon GS, Kwon TG, Chung SK, Yoo ES. Clinical significance of the De Ritis ratio for detecting prostate cancer in a repeat prostate biopsy. Investig Clin Urol 2019; 60:447-453. [PMID: 31692969 PMCID: PMC6821984 DOI: 10.4111/icu.2019.60.6.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/30/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose We evaluated factors predicting a positive repeat biopsy result in patients with an initial negative prostate biopsy result. Materials and Methods This study included 124 patients in whom prostate cancer (PCa) was not detected in the initial transrectal ultrasound-guided prostate biopsy and who underwent repeat biopsy from January 2011 to December 2017. Patients without PCa in both initial and repeat prostate biopsies were designated as group 1 (n=82), and those in whom PCa was detected on a repeat prostate biopsy were designated as group 2 (n=42). Among group 2 patients, 6 had insignificant PCa according to the Epstein criteria and were combined with group 1 patients to make up group A (n=88). Patients with significant PCa were categorized as group B (n=36). We compared clinicopathologic characteristics between the groups. Results Multivariate analysis showed that age (p=0.018) and detection of atypical small acinar proliferation (ASAP) or ≥3 cores of high-grade prostatic intraepithelial neoplasia (HGPIN) (p=0.011) on the initial biopsy were predictive factors for a positive result on a repeat biopsy. When we compared group A and group B, age (p=0.004) and the De Ritis ratio (p=0.024) were significantly higher in group B in the multivariate analysis. Conclusions Age and the detection of ASAP or ≥3 cores of HGPIN on the initial biopsy were associated with detection of PCa on a repeat biopsy. Age and the De Ritis ratio were found to be predictive factors for the detection of clinically significant PCa on a repeat biopsy.
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Affiliation(s)
- Heon Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea
| | - Jae-Wook Chung
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yun-Sok Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ghil Suk Yoon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Pathology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Kwang Chung
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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21
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Shah RB, Nguyen JK, Przybycin CG, Reynolds JP, Cox R, Myles J, Klein E, McKenney JK. Atypical intraductal proliferation detected in prostate needle biopsy is a marker of unsampled intraductal carcinoma and other adverse pathological features: a prospective clinicopathological study of 62 cases with emphasis on pathological outcomes. Histopathology 2019; 75:346-353. [DOI: 10.1111/his.13878] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/18/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Rajal B Shah
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
| | | | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
| | - Roni Cox
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
| | - Jonathan Myles
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
| | - Eric Klein
- Glickman Urological and Kidney Institute The Cleveland Clinic Cleveland OH USA
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute ClevelandOHUSA
- Glickman Urological and Kidney Institute The Cleveland Clinic Cleveland OH USA
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22
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Matheus WE, Ferreira U, Brandão EA, Ferruccio AA, Billis A. The importance of histopathologic review of biopsies in patients with prostate cancer referred to a tertiary uro-oncology center. Int Braz J Urol 2019; 45:32-37. [PMID: 30521172 PMCID: PMC6442135 DOI: 10.1590/s1677-5538.ibju.2018.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a “second opinion” to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.
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Affiliation(s)
- Wagner Eduardo Matheus
- Departamento de Cirurgia, Hospital das Clínicas da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Ubirajara Ferreira
- Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Elimilson A Brandão
- Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Aline A Ferruccio
- Departamento de Urooncologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,Pontifícia Universidade Católica de Campinas - PUC, Campus II, Campinas, SP, Brasil
| | - Athanase Billis
- Departamento de Anatomia Patológica da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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Eryilmaz IE, Aytac Vuruskan B, Kaygısız O, Egeli U, Tunca B, Kordan Y, Cecener G. RNA-based markers in biopsy cores with atypical small acinar proliferation: Predictive effect of T2E fusion positivity and MMP-2 upregulation for a subsequent prostate cancer diagnosis. Prostate 2019; 79:195-205. [PMID: 30294801 DOI: 10.1002/pros.23724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atypical small acinar proliferation (ASAP) is a precursor lesion of prostate cancer (PC), and PC develops from this suspicious focus or an unsampled malignant gland nearby. However, PC-related molecular alterations that could guide the timing of repeat biopsies and help monitor PC risk in ASAP-diagnosed patients have not been investigated. The purpose of this study was to first investigate the expression of seven different PC-related RNAs that included serine 2 (TMPRSS2): erythroblastosis virus E26 oncogene homolog (ERG) gene (TMPRSS2-ERG, T2E) fusion, alpha-methylacyl-CoA racemase (AMACR), kallikrein related peptidase 3 (KLK3), androgen receptor (AR), prostate cancer specific antigen 3 (PCA3), and matrix metalloproteinases (MMP)-2 and 9. METHODS PC-related RNAs were evaluated using a real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) system in pathologically ASAP-diagnosed prostate biopsy cores from 55 patients presenting with a normal digital rectal examination and a PSA level of 4-10 ng/mL. RESULTS We detected that positive T2E fusion status (P = 0.013) and the expression of AMACR (P = 0.016), AR (P = 0.016) and MMP-2 (P = 0.013) were independently and significantly associated with PC risk in ASAP patients. There were also several statistically significant correlations between expression levels. Additionally, we demonstrated that T2E fusion positive ASAP patients with higher MMP-2 expression were more likely to be diagnosed with PC at a subsequent biopsy during the follow-up period (P = 0.003). CONCLUSIONS Although, more clinical validations are needed for the stratification of PC risk in ASAP-diagnosed biopsy cores, our current results indicate that the coexistence of T2E fusion positivity with MMP-2 upregulation may help clinicians adjust their biopsy timetable and/or assessment of PC risk in ASAP-diagnosed patients with a PSA level of 4-10 ng/mL.
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Affiliation(s)
- I Ezgi Eryilmaz
- Medical Faculty, Medical Biology Department, Uludag University, Gorukle, Bursa, Turkey
| | - Berna Aytac Vuruskan
- Medical Faculty, Medical Pathology Department, Uludag University, Gorukle, Bursa, Turkey
| | - Onur Kaygısız
- Medical Faculty, Urology Department, Uludag University, Gorukle, Bursa, Turkey
| | - Unal Egeli
- Medical Faculty, Medical Biology Department, Uludag University, Gorukle, Bursa, Turkey
| | - Berrin Tunca
- Medical Faculty, Medical Biology Department, Uludag University, Gorukle, Bursa, Turkey
| | - Yakup Kordan
- Medical Faculty, Urology Department, Koc University, Topkapı, İstanbul, Turkey
| | - Gulsah Cecener
- Medical Faculty, Medical Biology Department, Uludag University, Gorukle, Bursa, Turkey
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24
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Fowke JH, Motley SS. Statin use linked with a decrease in the conversion from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. Carcinogenesis 2019; 39:819-825. [PMID: 29617729 DOI: 10.1093/carcin/bgy050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/02/2018] [Indexed: 12/31/2022] Open
Abstract
The roles of obesity, metabolic dysregulation and systemic inflammation to advance prostate carcinogenesis are unclear. This study investigates metabolic and inflammatory factors in the transition from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer (PC). We prospectively followed 160 men diagnosed with HGPIN at biopsy and therefore at high-risk and clinically monitored for PC. Analyses investigated body mass index (BMI), waist circumference, waist-hip ratio (WHR), height, fat mass, lean mass percent body fat, NSAIDs, statins, metformin, diabetes, hypertension, hypercholesterolemia representing metabolic dysregulation on the risk of a PC diagnosis during follow-up. Systemic inflammation was estimated through measurement of 13 plasma cytokine levels. Statin use was significantly linked with overall PC at follow-up [odds ratio (OR) = 0.45, (0.23, 0.91), P = 0.03], with a somewhat stronger link with high-grade [OR = 0.39, (0.15, 1.04), P = 0.06] PC compared with low-grade PC [OR = 0.50, (0.23, 1.12), P = 0.09]. Non-statin cholesterol-lowering medications, BMI, WHR, diabetes, hypertension and percent body fat were not significantly associated with PC. Although blood IL-12p70, IL-2 and IL-1β levels were significantly lower among statin users, inflammatory markers were not significantly linked with PC and did not explain the observed relationship between statins and lower PC risk. In summary, this prospective study of HGPIN patients at high risk for PC finds that statin use was significantly associated with reduced risk of PC detection at follow-up. Systemic markers of inflammation did not mediate this association, suggesting that statins affect PC progression through alternative pathways.
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Affiliation(s)
- Jay H Fowke
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saundra S Motley
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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26
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Lee TK, Ro JY. Spectrum of Cribriform Proliferations of the Prostate: From Benign to Malignant. Arch Pathol Lab Med 2018; 142:938-946. [DOI: 10.5858/arpa.2018-0005-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The presence of cribriform glands/ducts in the prostate can pose a diagnostic challenge. Cribriform glands/ducts include a spectrum of lesions, from benign to malignant, with vastly different clinical, prognostic, and treatment implications.
Objective.—
To highlight the diagnostic features of several entities with a common theme of cribriform architecture. We emphasize the importance of distinguishing among benign entities such as cribriform changes and premalignant to malignant entities such as high-grade prostatic intraepithelial neoplasia, atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, and invasive adenocarcinoma (acinar and ductal types). The diagnostic criteria, differential diagnosis, and clinical implications of these cribriform lesions are discussed.
Data Sources.—
Literature review of pertinent publications in PubMed up to calendar year 2017. Photomicrographs obtained from cases at the University of California at Irvine and authors' collections.
Conclusions.—
Although relatively uncommon compared with small acinar lesions (microacinar carcinoma and small gland carcinoma mimickers), large cribriform lesions are increasingly recognized and have become clinically and pathologically important. The spectrum of cribriform lesions includes benign, premalignant, and malignant lesions, and differentiating them can often be subtle and difficult. Intraductal carcinoma of the prostate in particular is independently associated with worse prognosis, and its presence in isolation should prompt definitive treatment. Patients with atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, or even focal cribriform pattern of invasive adenocarcinoma in biopsies would not be ideal candidates for active surveillance because of the high risk of adverse pathologic findings associated with these entities.
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Affiliation(s)
| | - Jae Y. Ro
- From the Department of Pathology and Urology, University of California Irvine, Orange (Dr Lee); and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weil Cornell Medical College, Houston, Texas (Dr Ro)
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27
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Eryilmaz IE, Kordan Y, Vuruskan BA, Kaygısız O, Tunca B, Cecener G. T2E ( TMPRSS2-ERG ) fusion transcripts are associated with higher levels of AMACR mRNA and a subsequent prostate cancer diagnosis in patients with atypical small acinar proliferation. Gene 2018; 645:69-75. [DOI: 10.1016/j.gene.2017.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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28
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Retrospective Analysis of Atypical Glands Suspicious for Carcinoma in Transurethral Resection of Prostate. Appl Immunohistochem Mol Morphol 2018; 26:186-191. [DOI: 10.1097/pai.0000000000000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Jamaspishvili T, Berman DM, Ross AE, Scher HI, De Marzo AM, Squire JA, Lotan TL. Clinical implications of PTEN loss in prostate cancer. Nat Rev Urol 2018; 15:222-234. [PMID: 29460925 DOI: 10.1038/nrurol.2018.9] [Citation(s) in RCA: 345] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genomic aberrations of the PTEN tumour suppressor gene are among the most common in prostate cancer. Inactivation of PTEN by deletion or mutation is identified in ∼20% of primary prostate tumour samples at radical prostatectomy and in as many as 50% of castration-resistant tumours. Loss of phosphatase and tensin homologue (PTEN) function leads to activation of the PI3K-AKT (phosphoinositide 3-kinase-RAC-alpha serine/threonine-protein kinase) pathway and is strongly associated with adverse oncological outcomes, making PTEN a potentially useful genomic marker to distinguish indolent from aggressive disease in patients with clinically localized tumours. At the other end of the disease spectrum, therapeutic compounds targeting nodes in the PI3K-AKT-mTOR (mechanistic target of rapamycin) signalling pathway are being tested in clinical trials for patients with metastatic castration-resistant prostate cancer. Knowledge of PTEN status might be helpful to identify patients who are more likely to benefit from these therapies. To enable the use of PTEN status as a prognostic and predictive biomarker, analytically validated assays have been developed for reliable and reproducible detection of PTEN loss in tumour tissue and in blood liquid biopsies. The use of clinical-grade assays in tumour tissue has shown a robust correlation between loss of PTEN and its protein as well as a strong association between PTEN loss and adverse pathological features and oncological outcomes. In advanced disease, assessing PTEN status in liquid biopsies shows promise in predicting response to targeted therapy. Finally, studies have shown that PTEN might have additional functions that are independent of the PI3K-AKT pathway, including those affecting tumour growth through modulation of the immune response and tumour microenvironment.
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Affiliation(s)
- Tamara Jamaspishvili
- Division of Cancer Biology and Genetics, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - David M Berman
- Division of Cancer Biology and Genetics, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ashley E Ross
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Angelo M De Marzo
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy A Squire
- Department of Pathology and Legal Medicine, University of Sao Paulo, Campus Universitario Monte Alegre, Ribeirão Preto, Brazil
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
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Evaluation of Prostate Needle Biopsies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:69-86. [DOI: 10.1007/978-3-319-99286-0_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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31
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Zhou M. High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate. Mod Pathol 2018; 31:S71-79. [PMID: 29297491 DOI: 10.1038/modpathol.2017.138] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Many prostate lesions have 'large gland' morphology with gland size similar to or larger than benign glands, complex glandular architecture including papillary, cribriform, and solid, and significant cytological atypia in glandular epithelium with nucleomegaly, prominent nucleoli, or anisonucleosis. The most common and clinically important lesions with 'large gland' morphology include high-grade prostatic intraepithelial neoplasia (HGPIN), PIN-like carcinoma, ductal adenocarcinoma, and intraductal carcinoma. These lesions have diverse clinical significance and management implications. HGPIN refers to proliferation of glandular epithelium that displays severe cytological atypia within the confines of prostatic ducts and acini. A HGPIN diagnosis in biopsies connotes ~25% risk of detection of cancer in repeat biopsies. It has been accepted as the main precursor lesion to invasive carcinoma. PIN-like carcinoma is a variant of acinar carcinoma that is morphologically reminiscent of HGPIN and is composed of large cancer glands lined with pseudostratified epithelium. Its clinical outcome is similar to that of usual acinar carcinomas and is graded as Gleason score 3+3=6. Ductal adenocarcinoma comprises large glands lined with tall columnar and pseudostratified epithelium. It is more aggressive than acinar carcinomas and is associated with higher stage disease and greater risk of PSA recurrence and mortality. Intraductal carcinoma is an intraglandular/ductal neoplastic proliferation of glandular epithelial cells that results in marked expansion of glandular architecture and nuclear atypia that often exceeds that in invasive carcinomas. In majority of cases, it is thought to represent retrograde extension of invasive carcinoma into pre-existing ducts and acini. Rarely it may represent a peculiar form of carcinoma with predilection for intraductal location. It is considered an adverse pathological feature and is seen almost always in high-grade and volume carcinoma and harbingers worse clinical outcomes. This article reviews 'new' information on the clinical and pathological features of HGPIN, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma, and focuses morphological features that aid the differential diagnosis.
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Affiliation(s)
- Ming Zhou
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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32
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A 12-year follow-up of ANNA/C-TRUS image-targeted biopsies in patients suspicious for prostate cancer. World J Urol 2017; 36:699-704. [PMID: 29275507 DOI: 10.1007/s00345-017-2160-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE PSA screening has been rehabilitated. PSA is not specific and can be elevated by benign reasons. Additionally, a subgroup of patients with prostate hyperplasia may harbor prostate cancer (PCa). During monitoring, the clinician aims to detect significant tumors in time, submitting patients to minimal psychological and physical burden, especially in men with high serum PSA and repeat biopsies. We aimed to determine long-term outcomes with respect to ANNA/C-TRUS ability to detect PCa with six targeted biopsies. METHODS A subset of 71 patients were enrolled. During monitoring, they were subjected to primary, secondary, or even multiple prostate biopsies when needed. Protocol monitoring included PSA measurements, digital rectal examination (DRE) and imaging. RESULTS The median follow-up was 12 years. Forty-one patients had a history of negative systematic random biopsies (1-3 sessions). Their age ranges 62-85 years, PSA 0.5-47.3 ng/ml, and the median prostate volume 11-255 cc. During monitoring, 15 patients were diagnosed with PCa. Only two harbored aggressive tumors. The median time to diagnosis was 6 years. All PCa patients are free from biochemical relapse. From the remaining 56 patients, 11 did not have any biopsies, 12 had one, 13 had two, and 20 had three or more biopsy sessions. CONCLUSIONS ANNA/C-TRUS is a useful method monitoring patients with a risk of PCa. 50-75% of the usually performed biopsy cores could be spared and, after 12 years, 97% of the patients were either without evidence of a PCa or were diagnosed with a good prognosis tumor.
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Srirangam V, Rai BP, Abroaf A, Agarwal S, Tadtayev S, Foley C, Lane T, Adshead J, Vasdev N. Atypical Small Acinar Proliferation and High Grade Prostatic Intraepithelial Neoplasia: Should We Be Concerned? An Observational Cohort Study with a Minimum Follow-Up of 3 Years. Curr Urol 2017; 10:199-205. [PMID: 29234263 DOI: 10.1159/000447181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction Atypical small acinar proliferation (ASAP) and high grade prostatic intraepithelial neoplasia (HGPIN) are considered precancerous. We aimed to measure the rate of repeat biopsy and adenocarcinoma in patients with ASAP and HGPIN and identify any clinico-pathologic parameters at diagnosis of ASAP/HGPIN that are predictive of adenocarcinoma. Materials and Methods Patients with a diagnosis of ASAP/HGPIN with no previous or concomitant cancer were identified. Prostate specific antigen (PSA) and magnetic resonance imaging (MRI) changes were monitored. Re-biopsy was at clinician discretion. Results Nineteen were diagnosed with ASAP and 17 with HGPIN. Seven with ASAP (37%) and 6 with HGPIN (35%) underwent re-biopsy. Three (16%) with ASAP and 5 with HGPIN (29%) were diagnosed with adenocarcinoma. The difference in cancer detection rates between ASAP and HGPIN was not significant (p = 0.35). Five (14%) in total required definitive therapy for adenocarcinoma. Twenty-three (64%) did not undergo repeat biopsy. Parameters at diagnosis of HGPIN and ASAP, including PSA, prostate volume and PSA density, were compared between the cancer and non-cancer cohorts with none found to be predictive of adenocarcinoma. Conclusion By monitoring PSA and MRI changes, we managed to spare re-biopsy in two-thirds of patients. Further evaluation is necessary to characterize a surveillance protocol in these populations.
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Affiliation(s)
| | - Bhavan Prasad Rai
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Ahmed Abroaf
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | | | - Sergey Tadtayev
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Charlotte Foley
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Tim Lane
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Jim Adshead
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
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Nakai Y, Tanaka N, Miyake M, Hori S, Tatsumi Y, Morizawa Y, Fujii T, Konishi N, Fujimoto K. Atypical small acinar proliferation and two or more cores of high-grade intraepithelial neoplasia on a previous prostate biopsy are significant predictors of cancer during a transperineal template-guided saturation biopsy aimed at sampling one core for each 1 mL of prostate volume. Res Rep Urol 2017; 9:187-193. [PMID: 29034221 PMCID: PMC5614783 DOI: 10.2147/rru.s148424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to evaluate whether high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) predict prostate cancer (PCa) during repeat transperineal template saturation biopsy with a high number of cores per prostate volume in patients with persistent clinical suspicion of PCa who underwent at least one previous negative transrectal ultrasound (TRUS)-guided biopsy. Methods We retrospectively evaluated 135 consecutive patients with persistent clinical suspicion of PCa, despite a set of negative TRUS-guided biopsies and increasing prostate-specific antigen levels; abnormal findings on digital rectal examination, TRUS, or magnetic resonance imaging; previous biopsy showing HGPIN; and previous biopsy showing atypical glands. Transperineal template saturation biopsy (TTSB) was performed at 5mm intervals to sample one core for each 1 mL of prostate volume. Results The median rate of biopsy cores per prostate volume was 1.00 (range: 0.75–1.39). The PCa detection rates in patients who were diagnosed with HGPIN, or had two or more cores of HGPIN or ASAP, were 53% (9/17), 89% (8/9), and 83% (10/12), respectively. Two or more HGPIN cores and ASAP were positive predictors of PCa on TTSB. The high-grade cancer rates (Gleason score [GS] ≥7) in patients with ASAP and two or more cores of HGPIN were 20% and 80%, respectively. The cancer detection rate represented by a GS score ≥8 in patients with ASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy was 5.5% (1/18). Conclusion ASAP or two or more cores of HGPIN at a previous TRUS-guided biopsy strongly indicated the presence of PCa on TTSB.
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Affiliation(s)
| | | | | | - Shunta Hori
- Department of Urology, Nara Medical University
| | - Yoshihiro Tatsumi
- Department of Urology, Nara Medical University.,Department of Pathology, Nara Medical University, Kashihara-shi, Nara, Japan
| | | | - Tomomi Fujii
- Department of Pathology, Nara Medical University, Kashihara-shi, Nara, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University, Kashihara-shi, Nara, Japan
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Atypical Small Acinar Proliferation and High-grade Prostatic Intraepithelial Neoplasia in the Era of Multiparametric Magnetic Resonance Imaging: A Contemporary Review. Urology 2017; 107:5-10. [DOI: 10.1016/j.urology.2017.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 12/28/2022]
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36
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Tosoian JJ, Alam R, Ball MW, Carter HB, Epstein JI. Managing high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands on prostate biopsy. Nat Rev Urol 2017; 15:55-66. [PMID: 28858331 DOI: 10.1038/nrurol.2017.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate biopsy is the gold standard for diagnosing prostate cancer and reliable pathological assessment is essential for guiding management. Research efforts over the past few years have aimed to establish a more universal approach to management according to pathological grading; however, high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands suspicious for carcinoma are two diagnoses without standardized follow-up and treatment pathways. Much of this uncertainty is due to limited evidence describing the subsequent rates of cancer and high-grade cancer when HGPIN or atypical glands are detected on initial biopsy. Fortunately, data from the past decade have shed light on these phenomena, and an improved understanding of the implications of the presence of HGPIN and atypical glands on prostate biopsy means that clinical recommendations can be made for the management of patients with these diagnoses.
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Affiliation(s)
- Jeffrey J Tosoian
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Mark W Ball
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - H Ballentine Carter
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland 21287, USA
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg 2242, Baltimore, Maryland 21231, USA
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Sanguedolce F, Cormio A, Musci G, Troiano F, Carrieri G, Bufo P, Cormio L. Typing the atypical: Diagnostic issues and predictive markers in suspicious prostate lesions. Crit Rev Clin Lab Sci 2017; 54:309-325. [PMID: 28828885 DOI: 10.1080/10408363.2017.1363155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As much as 5% of prostate biopsies yield findings equivocal for malignancy even for skilled uropathologist; such "grey zone" lesions have been addressed in many ways, although the acronym ASAP (atypical small acinar proliferation) is the most widely used when referring to an atypical focus suspicious, but not diagnostic, for malignancy. Since the introduction of this diagnostic category more than 20 years ago, debate has ensued over its histological characterization and clinical significance. Pathology reporting of ASAP, commonly based on strict morphological criteria and traditional immunohistochemical markers such as basal cell antibodies, has been improved by recent availability of novel immunohistochemical markers such as AMACR and ERG. Further pathological issues, such as the role of pre-analytical variables, number of tissue levels, interobserver variability, and association with prostatic intraepithelial neoplasia also play a role in the optimal assessment of ASAP. Apart from diagnostic issues, a major issue is ASAP predictive value for prostate cancer on repeat biopsy. Therefore, attempts have been made to identify clinical and biological parameters that could predict subsequent diagnosis of malignancy as well as define time and modality of repeat biopsy. Finally, pathological features of cancers detected after a previous ASAP diagnosis are compared with those diagnosed at first prostate biopsy.
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Affiliation(s)
| | - Antonella Cormio
- b Department of Biosciences, Biotechnologies, and Biopharmaceutics , University of Bari , Bari , Italy
| | - Giovanni Musci
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Francesco Troiano
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Giuseppe Carrieri
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
| | - Pantaleo Bufo
- a Department of Pathology , University of Foggia , Foggia , Italy
| | - Luigi Cormio
- c Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy
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Shah RB, Yoon J, Liu G, Tian W. Atypical intraductal proliferation and intraductal carcinoma of the prostate on core needle biopsy: a comparative clinicopathological and molecular study with a proposal to expand the morphological spectrum of intraductal carcinoma. Histopathology 2017; 71:693-702. [DOI: 10.1111/his.13273] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Rajal B Shah
- Division of Pathology; Miraca Life Sciences; Irving TX USA
- Department of Pathology; Baylor College of Medicine; Houston TX USA
| | - Jiyoon Yoon
- Division of Pathology; Miraca Life Sciences; Irving TX USA
| | - Gang Liu
- University of Toledo; Toledo OH USA
| | - Wei Tian
- Division of Pathology; Miraca Life Sciences; Irving TX USA
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Abstract
CONTEXT - Precursor lesions of urologic malignancies are established histopathologic entities, which are important not only to recognize for clinical purposes, but also to further investigate at the molecular level in order to gain a better understanding of the pathogenesis of these malignancies. OBJECTIVE - To provide a brief overview of precursor lesions to the most common malignancies that develop within the genitourinary tract with a focus on their clinical implications, histologic features, and molecular characteristics. DATA SOURCES - Literature review from PubMed, urologic pathology textbooks, and the 4th edition of the World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs. All photomicrographs were taken from cases seen at Weill Cornell Medicine or from the authors' personal slide collections. CONCLUSIONS - The clinical importance and histologic criteria are well established for the known precursor lesions of the most common malignancies throughout the genitourinary tract, but further investigation is warranted at the molecular level to better understand the pathogenesis of these lesions. Such investigation may lead to better risk stratification of patients and potentially novel treatments.
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Abstract
The category of intraductal lesions of the prostate includes a range of primary prostatic and nonprostatic processes with wide variation in prognosis and recommended follow-up. Studies have shown that pathologists are uncomfortable with the diagnosis of these lesions and that the diagnostic reproducibility is low in this category. Despite the diagnostic difficulty, their accurate and reproducible diagnosis is critical for patient management. This review aims to highlight the diagnostic criteria, prognosis, and treatment implications of common intraductal lesions of the prostate. It focuses on the recognition of intraductal carcinoma of the prostate (IDC-P) in prostate needle biopsies and how to distinguish it from its common mimickers, including high-grade prostatic intraepithelial neoplasia, invasive cribriform prostatic adenocarcinoma, urothelial carcinoma extending into prostatic ducts, and prostatic ductal adenocarcinoma. IDC-P is independently associated with higher risk disease, and its identification in a needle biopsy, even in the absence of invasive carcinoma, should compel definitive treatment. Conversely, high-grade prostatic intraepithelial neoplasia has a much better prognosis and in limited quantities does not even warrant a repeat biopsy. IDC-P must be distinguished from urothelial carcinoma involving prostatic ducts, as recommended treatment varies markedly. Ductal adenocarcinoma may confuse the pathologist and clinician by overlapping terminology, and morphology may also mimic IDC-P on occasion. The use of ancillary testing with immunohistochemistry and molecular markers has also been reviewed.
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Sun F, Báez-Díaz C, Sánchez-Margallo FM. Canine prostate models in preclinical studies of minimally invasive interventions: part I, canine prostate anatomy and prostate cancer models. Transl Androl Urol 2017; 6:538-546. [PMID: 28725597 PMCID: PMC5503961 DOI: 10.21037/tau.2017.03.61] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The high prevalence of prostate cancer (PCa) in elderly men and technical advances in early detection of localized PCa have led to continued efforts to develop new therapeutic options of minimally invasive nature in current urologic oncology community. Increasing newly emerging therapies are undergoing preclinical tests on the technical feasibility, efficacy and safety in animal experiments. The dog is an ideal large animal because of its similar anatomy to human and the capability allowing the use of the same medical devices applied in future clinical trials. Awareness of the local anatomy, microvascular structure, and histological features of the prostate in dogs is essential to experimental design and performance of the tested procedures and techniques. Although dogs with spontaneous PCa may be used in preclinical investigation, the low incidence and pathological features limit its utility. Alternatively, canine orthotopic PCa models have a great potential in preclinical research for this purpose. The goal of this review is to provide detailed anatomic and histological information of the canine prostate, outline the pathological and clinical characteristics of spontaneous PCa in dogs and discuss the current status of canine orthotopic PCa models.
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Affiliation(s)
- Fei Sun
- Jesus Uson Minimally Invasive Surgery Centre, Cáceres, Spain
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Atypical Intraductal Cribriform Proliferations of the Prostate Exhibit Similar Molecular and Clinicopathologic Characteristics as Intraductal Carcinoma of the Prostate. Am J Surg Pathol 2017; 41:550-556. [DOI: 10.1097/pas.0000000000000794] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kumar NB, Pow-Sang JM, Spiess PE, Park JY, Chornokur G, Leone AR, Phelan CM. Chemoprevention in African American Men With Prostate Cancer. Cancer Control 2017; 23:415-423. [PMID: 27842331 DOI: 10.1177/107327481602300413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recommendations for cancer screening are uncertain for the early detection or prevention of prostate cancer in African American men. Thus, chemoprevention strategies are needed to specifically target African American men. METHODS The evidence was examined on the biological etiology of disparities in African Americans related to prostate cancer. Possible chemopreventive agents and biomarkers critical to prostate cancer in African American men were also studied. RESULTS High-grade prostatic intraepithelial neoplasia may be more prevalent in African American men, even after controlling for age, prostate-specific antigen (PSA) level, abnormal results on digital rectal examination, and prostate volume. Prostate cancer in African American men can lead to the overexpression of signaling receptors that may mediate increased proliferation, angiogenesis, and decreased apoptosis. Use of chemopreventive agents may be useful for select populations of men. CONCLUSIONS Green tea catechins are able to target multiple pathways to address the underlying biology of prostate carcinogenesis in African American men, so they may be ideal as a chemoprevention agent in these men diagnosed with high-grade prostatic intraepithelial neoplasia.
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Affiliation(s)
- Nagi B Kumar
- Department of Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.
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Wang X, Han J, Hardie DB, Yang J, Pan J, Borchers CH. Metabolomic profiling of prostate cancer by matrix assisted laser desorption/ionization-Fourier transform ion cyclotron resonance mass spectrometry imaging using Matrix Coating Assisted by an Electric Field (MCAEF). BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2016; 1865:755-767. [PMID: 28017863 DOI: 10.1016/j.bbapap.2016.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/15/2022]
Abstract
In this work, we combined the use of two MALDI matrices (quercetin and 9-aminoacridine), a recently developed new matrix coating technique - matrix coating assisted by an electric field (MCAEF), and matrix-assisted laser desorption/ionization - Fourier transform ion cyclotron resonance mass spectrometry (MALDI-FTICRMS) to detect and image endogenous compounds in the cancerous and non-cancerous regions of three human prostate cancer (stage II) tissue specimens. After three rounds of imaging data acquisitions (i.e., quercetin for positive and negative ion detection and 9-aminoacridine for negative ion detection), and metabolite identification, a total of 1091 metabolites including 1032 lipids and 59 other metabolites were routinely detected and successfully localized. Of these compounds, 250 and 217 were only detected in either the cancerous or the non-cancerous regions respectively, although we cannot rule out the presence of these metabolites at concentrations below the detection limit. In addition, 152 of the other 624 metabolites showed differential distributions (p<0.05, t-test) between the two regions of the tissues. Further studies on a larger number of clinical specimens will need to be carried out to confirm this large number of apparently cancer-related metabolites. The successful determination of the spatial locations and abundances of these endogenous biomolecules indicated significant metabolism abnormalities - e.g., increased energy charge and under-expression of neutral acyl glycerides, in the prostate cancer samples. To our knowledge, this work has resulted in MALDI-MS imaging of the largest group of metabolites in prostate cancer thus far and demonstrated the importance of using complementary matrices for comprehensive metabolomic imaging by MALDI-MS. This article is part of a Special Issue entitled: MALDI Imaging, edited by Dr. Corinna Henkel and Prof. Peter Hoffmann.
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Affiliation(s)
- Xiaodong Wang
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Jun Han
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Darryl B Hardie
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Juncong Yang
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Jingxi Pan
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada
| | - Christoph H Borchers
- University of Victoria-Genome British Columbia Proteomics Centre, Vancouver Island Technology Park, #3101-4464 Markham St., Victoria, BC V8Z 7X8, Canada; Department of Biochemistry and Microbiology, University of Victoria, Petch Building Room 207, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada.
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Merrick GS, Galbreath RW, Bennett A, Butler WM, Amamovich E. Incidence, grade and distribution of prostate cancer following transperineal template-guided mapping biopsy in patients with atypical small acinar proliferation. World J Urol 2016; 35:1009-1013. [PMID: 27900453 DOI: 10.1007/s00345-016-1976-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To evaluate the role of transperineal template-guided mapping biopsy (TTMB) in patients with atypical small acinar proliferation (ASAP) diagnosed via transrectal ultrasound-guided needle biopsy (TRUS). METHODS In total, 132 consecutive patients with TRUS-diagnosed ASAP underwent TTMB by means of an anatomic-based technique with sampling of 24 biopsy regions. For each of the 24 regions, 1-3 biopsy cores were obtained (depending on prostate size). No patient underwent pre-biopsy MRI imaging. The Gleason score, location of each positive biopsy core, the number of biopsy cores and percent involvement of each core were recorded. Anterior versus posterior cancer distribution was determined for both low- and high-grade (Gleason score ≥7) cancer. RESULTS The mean patient age was 63.8 years with a mean PSA of 6.8 ng/mL. Of the 132 patients, 86 (65.2%) were diagnosed with prostate cancer. Of the entire cohort, 47 patients (54.7% of cancer patients and 35.6% of the entire cohort) were diagnosed with Gleason score ≥7. For both low- and high-grade cancers, the anterior gland and especially the anterior apex were the most common cancer locations. CONCLUSION In patients with ASAP, TTMB diagnosed prostate cancer in 65.2% of patients and 35.6% of the entire cohort had high-grade prostate cancer. A predilection for anterior-based cancers, especially the anterior apex, was identified. Our study may serve as a baseline reference for MRI-guided biopsy regimens.
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Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, 26003, USA. .,Department of Urology, Wheeling Hospital, Wheeling, WV, USA.
| | - Robert W Galbreath
- Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, 26003, USA.,Ohio University Eastern, St. Clairsville, OH, USA
| | - Abbey Bennett
- Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, 26003, USA
| | - Wayne M Butler
- Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, 26003, USA
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Cool DW, Romagnoli C, Izawa JI, Chin J, Gardi L, Tessier D, Mercado A, Mandel J, Ward AD, Fenster A. Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation. Can Urol Assoc J 2016; 10:342-348. [PMID: 27800057 DOI: 10.5489/cuaj.3831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). MATERIALS 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the pre-biopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. RESULTS Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. CONCLUSIONS MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Aaron D Ward
- Department of Biophysics; University of Western Ontario, London, ON, Canada
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Voltaggio L, Cimino-Mathews A, Bishop JA, Argani P, Cuda JD, Epstein JI, Hruban RH, Netto GJ, Stoler MH, Taube JM, Vang R, Westra WH, Montgomery EA. Current concepts in the diagnosis and pathobiology of intraepithelial neoplasia: A review by organ system. CA Cancer J Clin 2016; 66:408-36. [PMID: 27270763 DOI: 10.3322/caac.21350] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Answer questions and earn CME/CNE In this report, a team of surgical pathologists has provided a review of intraepithelial neoplasia in a host of (but not all) anatomic sites of interest to colleagues in various medical specialties, namely, uterine cervix, ovary, breast, lung, head and neck, skin, prostate, bladder, pancreas, and esophagus. There is more experience with more readily accessible sites (such as the uterine cervix and skin) than with other anatomic sites, and the lack of uniform terminology, together with divergent biology in various sites, makes it difficult to paint a unifying, relevant portrait. The authors' aim was to provide a framework from which to move forward as we care for patients with such precancerous lesions. CA Cancer J Clin 2016;66:408-436. © 2016 American Cancer Society.
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Affiliation(s)
- Lysandra Voltaggio
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ashley Cimino-Mathews
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Justin A Bishop
- Associate Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Pedram Argani
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan D Cuda
- Assistant Professor of Dermatology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan I Epstein
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
- Professor of Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
| | - Ralph H Hruban
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - George J Netto
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark H Stoler
- Professor of Pathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA
| | - Janis M Taube
- Associate Professor of Dermatology and Pathology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Russell Vang
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - William H Westra
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Elizabeth A Montgomery
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
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Rafailov S, Cammack S, Stone BA, Katz AE. The Role of Zyflamend, an Herbal Anti-inflammatory, as a Potential Chemopreventive Agent Against Prostate Cancer: A Case Report. Integr Cancer Ther 2016; 6:74-6. [PMID: 17351029 DOI: 10.1177/1534735406298843] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Correlation between dietary intake and occurrence of prostate cancer has gained significant support in recent years. Although a direct correlation has yet to be proven between inflammation and prostate cancer, chronic or recurrent inflammation has been hypothesized to be the major predisposing factor for this disease. The authors have been studying Zyflamend, a novel herbal anti-inflammatory mixture, as a potential chemopreventive agent in a phase 1 trial for patients diagnosed with prostatic intraepithelial neoplasia. They report the results of the first patient who has completed the 18-month study in which 24 patients were assigned to a cohort and placed on successive herbal supplement regimen starting with Zyflamend alone.
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Affiliation(s)
- Samuil Rafailov
- Department of Urology, Columbia University, New York, New York, USA
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49
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A Clinicopathological Profile of Prostate Cancer in Trinidad and Tobago. Adv Urol 2016; 2016:2075021. [PMID: 27493662 PMCID: PMC4967437 DOI: 10.1155/2016/2075021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/23/2016] [Indexed: 12/13/2022] Open
Abstract
Aim. To conduct a clinicopathological review of all prostate biopsies performed in a tertiary referral centre in Trinidad and Tobago over a period of 30 months. Methods. The records of all patients who had prostate biopsies from January 2012 to July 2014 were reviewed. Clinical and pathologic data were compiled and subsequently analysed using SPSS version 20. Results. From January 2012 to July 2014, 617 transrectal ultrasound guided prostate biopsies were performed. Pathological data were found for 546 patients of whom 283 (51.8%) were confirmed carcinoma of the prostate. Moderately differentiated tumors (Gleason 7) were the most common group. Using the D'Amico risk classification, most cases were found to be high risk (63.1%). Afro-Trinidadians comprised 72.1% of the patients with prostate cancer. Afro-Trinidadians were also more likely to have high risk and high grade disease as well as high PSA values. Conclusion. This study demonstrates that over half of our biopsies are eventually positive for cancer and most cases were high risk. Afro-Trinidadians comprised a disproportionate number of those diagnosed with prostate cancer and had a greater risk of high risk disease.
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50
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Morais CL, Guedes LB, Hicks J, Baras AS, De Marzo AM, Lotan TL. ERG and PTEN status of isolated high-grade PIN occurring in cystoprostatectomy specimens without invasive prostatic adenocarcinoma. Hum Pathol 2016; 55:117-25. [PMID: 27189342 DOI: 10.1016/j.humpath.2016.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/14/2016] [Accepted: 04/22/2016] [Indexed: 11/17/2022]
Abstract
High-grade prostatic intraepithelial neoplasia (HGPIN) is widely believed to represent a precursor to invasive prostatic adenocarcinoma. However, recent molecular studies have suggested that retrograde spread of invasive adenocarcinoma into pre-existing prostatic ducts can morphologically mimic HGPIN. Thus, previous molecular studies characterizing morphologically identified HGPIN occurring in radical prostatectomies or needle biopsies with concurrent invasive carcinoma may be partially confounded by intraductal spread of invasive tumor. To assess ERG and PTEN status in HGPIN foci likely to represent true precursor lesions in the prostate, we studied isolated HGPIN occurring without associated invasive adenocarcinoma in cystoprostatectomies performed at Johns Hopkins between 2009 and 2014. Of 344 cystoprostatectomies, 33% (115/344) contained invasive prostatic adenocarcinoma in the partially submitted prostate (10 blocks/case on average) and were excluded from the study. Of the remaining cases without sampled cancer, 32% (73/229) showed 133 separate foci of HGPIN and were immunostained for ERG and PTEN using genetically validated protocols. Of foci of HGPIN with evaluable staining, 7% (8/107) were positive for ERG. PTEN loss was not seen in any HGPIN lesion (0/88). Because these isolated HGPIN foci at cystoprostatectomy are unlikely to represent retrograde spread of invasive tumor, our study suggests that ERG rearrangement, but not PTEN loss, is present in a minority of potential neoplastic precursor lesions in the prostate.
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Affiliation(s)
- Carlos L Morais
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21231
| | - Liana B Guedes
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21231
| | - Jessica Hicks
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21231
| | | | - Angelo M De Marzo
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21231; Urology, Johns Hopkins School of Medicine, Baltimore, MD 21231; Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21231
| | - Tamara L Lotan
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21231; Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21231.
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