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Pathology - Prostate Carcinoma
Definition: A malignant epithelial tumor originating in the prostate. Epidemiology: The predominant malignant neoplasm in males. • Increasing prevalence attributed to prolonged life expectancy and enhanced detection methods. • A less significant contributor to cancer-related mortality, as numerous instances have a rather indolent progression.
Aetiology: Racial background and genetic predispositions are significant, with a 5–10-fold elevated risk in males possessing two or more affected first-degree relatives. • Dietary correlation with animal-derived items, especially red meat.
Carcinogenesis • Originates from a precursor lesion termed prostatic intraepithelial neoplasia (PIN), distinguished by the neoplastic transformation of the epithelial lining of the prostatic ducts and acini. • Contains mutations in several genes, including GST-pi, PTEN, AMACR, p27, and E-cadherin (notably, these are not conventional tumor suppressor genes or oncogenes). The majority of prostate cancers are asymptomatic and are detected when a needle biopsy is conducted due to an elevated prostate-specific antigen (PSA) level or a suspicious finding during a digital rectal examination (DRE). • LUTS may be evident. • Infrequently, patients exhibit symptoms indicative of metastatic disease.
Macroscopy • Initial instances of latent prostate cancer are improbable to be discernible macroscopically. • Larger tumors may present as firmer regions that contrast in color with the adjacent prostatic tissue.
Histopathology • Nearly all prostate carcinomas are glandular epithelial neoplasms, specifically adenocarcinomas. • A principal diagnostic characteristic of prostate cancer is the atypical architecture of the malignant glands, which exhibit crowding and a disorganized growth pattern relative to adjacent normal acini. • Malignant epithelial cells exhibit enlarged nuclei with conspicuous nucleoli and denser amphophilic cytoplasm. • Malignant glands frequently contain intraluminal crystalloids (dense crystalline structures), pink secretions, or blue-tinged mucin. • A morphological diagnosis or suspicion of prostate carcinoma can be immunohistochemically validated by the absence of basal cells encircling the malignant glands. Typical basal cell markers employed for this purpose encompass p63 and high molecular weight keratins.
Prognosis • The primary determinant is the histological grade, referred to as the Gleason score, named after the pathologist who initially developed the system. • The Gleason score varies from 2 to 10 and is derived by summing two integers between 1 and 5, reflecting the architectural growth patterns of the tumor. In actuality, patterns 1 and 2 are rarely identified, resulting in nearly all prostate tumors having a Gleason score ranging from 6 to 10. A higher score correlates with inferior tumor differentiation and adverse outcomes. Additional significant factors include the PSA level and the illness stage.
Prostate cancer screening • The utilization of serum PSA for screening is a contentious issue. • Currently, the majority of countries lack a systematic prostate screening program. Current research indicates that screening may lead to overdiagnosis and overtreatment of numerous men with prostate tumors that are unlikely to exhibit aggressive behavior.
TNM 7 pathological staging of prostatic carcinomas
Primary tumour (T)
pT1a: tumour incidental histologic fi nding in 5 % or less of TURP tissue.
pT1b: tumour incidental histological fi nding in more than 5 % of TURP
tissue.
pT1c: tumour identifi ed by needle biopsy (e.g. because of elevated PSA).
pT2a: tumour involves one half of one lobe or less.
pT2b: tumour involves more than half of one lobe, but not both lobes.
pT2c: tumour involves both lobes.
pT3a: extracapsular extension or microscopic bladder neck invasion.
pT3b: tumour invades seminal vesicle(s).
pT4: tumour invades adjacent structures other than seminal vesicles.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: regional lymph node metastasis
Definition: A malignant epithelial tumor originating in the prostate. Epidemiology: The predominant malignant neoplasm in males. • Increasing prevalence attributed to prolonged life expectancy and enhanced detection methods. • A less significant contributor to cancer-related mortality, as numerous instances have a rather indolent progression.
Aetiology: Racial background and genetic predispositions are significant, with a 5–10-fold elevated risk in males possessing two or more affected first-degree relatives. • Dietary correlation with animal-derived items, especially red meat.
Carcinogenesis • Originates from a precursor lesion termed prostatic intraepithelial neoplasia (PIN), distinguished by the neoplastic transformation of the epithelial lining of the prostatic ducts and acini. • Contains mutations in several genes, including GST-pi, PTEN, AMACR, p27, and E-cadherin (notably, these are not conventional tumor suppressor genes or oncogenes). The majority of prostate cancers are asymptomatic and are detected when a needle biopsy is conducted due to an elevated prostate-specific antigen (PSA) level or a suspicious finding during a digital rectal examination (DRE). • LUTS may be evident. • Infrequently, patients exhibit symptoms indicative of metastatic disease.
Macroscopy • Initial instances of latent prostate cancer are improbable to be discernible macroscopically. • Larger tumors may present as firmer regions that contrast in color with the adjacent prostatic tissue.
Histopathology • Nearly all prostate carcinomas are glandular epithelial neoplasms, specifically adenocarcinomas. • A principal diagnostic characteristic of prostate cancer is the atypical architecture of the malignant glands, which exhibit crowding and a disorganized growth pattern relative to adjacent normal acini. • Malignant epithelial cells exhibit enlarged nuclei with conspicuous nucleoli and denser amphophilic cytoplasm. • Malignant glands frequently contain intraluminal crystalloids (dense crystalline structures), pink secretions, or blue-tinged mucin. • A morphological diagnosis or suspicion of prostate carcinoma can be immunohistochemically validated by the absence of basal cells encircling the malignant glands. Typical basal cell markers employed for this purpose encompass p63 and high molecular weight keratins.
Prognosis • The primary determinant is the histological grade, referred to as the Gleason score, named after the pathologist who initially developed the system. • The Gleason score varies from 2 to 10 and is derived by summing two integers between 1 and 5, reflecting the architectural growth patterns of the tumor. In actuality, patterns 1 and 2 are rarely identified, resulting in nearly all prostate tumors having a Gleason score ranging from 6 to 10. A higher score correlates with inferior tumor differentiation and adverse outcomes. Additional significant factors include the PSA level and the illness stage.
Prostate cancer screening • The utilization of serum PSA for screening is a contentious issue. • Currently, the majority of countries lack a systematic prostate screening program. Current research indicates that screening may lead to overdiagnosis and overtreatment of numerous men with prostate tumors that are unlikely to exhibit aggressive behavior.
TNM 7 pathological staging of prostatic carcinomas
Primary tumour (T)
pT1a: tumour incidental histologic fi nding in 5 % or less of TURP tissue.
pT1b: tumour incidental histological fi nding in more than 5 % of TURP
tissue.
pT1c: tumour identifi ed by needle biopsy (e.g. because of elevated PSA).
pT2a: tumour involves one half of one lobe or less.
pT2b: tumour involves more than half of one lobe, but not both lobes.
pT2c: tumour involves both lobes.
pT3a: extracapsular extension or microscopic bladder neck invasion.
pT3b: tumour invades seminal vesicle(s).
pT4: tumour invades adjacent structures other than seminal vesicles.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: regional lymph node metastasis
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