Abstract
Management of patients presenting with elevated serum prostate-specific antigen levels, or those with previously diagnosed prostate carcinoma, is very much dependent on the pathology report on needle biopsy or radical prostatectomy specimens obtained from these patients. In contrast to a diagnosis of benignity or high-grade prostatic intraepithelial neoplasia, a diagnosis of atypia on needle core biopsy is usually an indication for a repeat biopsy; however, it is important to understand that atypia and other related terms are not specific diagnoses. The pathology report on different prostate specimens with a diagnosis of carcinoma usually includes the Gleason grade and extent of carcinoma, among other morphological prognostic and predictive factors. Understanding the significance of these morphological factors and how they are evaluated and incorporated into the pathology report, as well as newer developments in this field, can assist urologists in the interpretation of the pathological findings and ultimately lead to better clinical care.
Similar content being viewed by others
References and Recommended Reading
Amin M, Boccon-Gibod L, Egevad L, et al.: Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens. Scand J Urol Nephrol Suppl 2005, 216:20–33.
Epstein JI, Srigley J, Grignon D, Humphrey P: Recommendations for the reporting of prostate carcinoma: Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol 2008, 129:24–30.
Srigley JR, Amin MB, Epstein JI, et al.: Updated protocol for the examination of specimens from patients with carcinomas of the prostate gland. Arch Pathol Lab Med 2006, 130:936–946.
Epstein JI, Allsbrook WCJ, Amin MB, Egevad LL: The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005, 29:1228–1242.
Heffner DK: Pathologists are from Mercury, clinicians are from Uranus: the perverted prospects for perceptual pathology. Ann Diagn Pathol 2008, 12:304–309.
Powsner SM, Costa J, Homer RJ: Clinicians are from Mars and pathologists are from Venus. Arch Pathol Lab Med 2000, 124:1040–1046.
Hameed O, Humphrey PA: Immunohistochemical evaluation of prostate needle biopsies using saved interval sections vs. new recut sections from the block: a prospective comparison. Am J Clin Pathol 2009, 131:683–687.
Viglione MP, Potter S, Epstein JI: Should BPH be diagnosed on prostate needle biopsy? Mod Pathol 2001, 14:739.
Nadler RB, Humphrey PA, Smith DS, et al.: Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 1995, 154:407–413.
Oppenheimer JR, Kahane H, Epstein JI: Granulomatous prostatitis on needle biopsy. Arch Pathol Lab Med 1997, 121:724–729.
Postma R, Schroder FH, van der Kwast TH: Atrophy in prostate needle biopsy cores and its relationship to prostate cancer incidence in screened men. Urology 2005, 65:745–749.
Ayala AG, Ro JY: Prostatic intraepithelial neoplasia: recent advances. Arch Pathol Lab Med 2007, 131:1257–1266.
Godoy G, Taneja SS: Contemporary clinical management of isolated high-grade prostatic intraepithelial neoplasia. Prostate Cancer Prostatic Dis 2008, 11:20–31.
Akhavan A, Keith JD, Bastacky SI, et al.: The proportion of cores with high-grade prostatic intraepithelial neoplasia on extended-pattern needle biopsy is significantly associated with prostate cancer on site-directed repeat biopsy. BJU Int 2007, 99:765–769.
Epstein JI, Potter SR: The pathological interpretation and significance of prostate needle biopsy findings: implications and current controversies. J Urol 2001, 166:402–410.
Iczkowski KA: Current prostate biopsy interpretation: criteria for cancer, atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, and use of immunostains. Arch Pathol Lab Med 2006, 130:835–843.
Allen EA, Kahane H, Epstein JI: Long-term follow-up of men with an initial atypical prostate needle biopsy. Lab Invest 2001, 81:577.
Hameed O, Humphrey PA: Immunohistochemistry in diagnostic surgical pathology of the prostate. Semin Diagn Pathol 2005, 22:88–104.
Hameed O, Humphrey PA: Immunohistochemistry in the diagnosis of minimal prostate cancer. Curr Diagn Pathol 2006, 12:279–291.
Kirby RS, Pool JL: Alpha adrenoceptor blockade in the treatment of benign prostatic hyperplasia: past, present and future. Br J Urol 1997, 80:521–532.
Keoghane SR, Cranston DW: A critical overview on the role of the Nd:YAG laser in the treatment of benign prostatic hypertrophy. Eur Urol 1994, 26:193–196.
Walsh PC, Epstein JI, Lowe FC: Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J Urol 1987, 138:823–827.
Hodge KK, McNeal JE, Terris MK, Stamey TA: Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989, 142:71–74.
Thorson P, Humphrey PA: Minimal adenocarcinoma in prostate needle biopsy tissue. Am J Clin Pathol 2000, 114:896–909.
Rubin MA, Dunn R, Kambham N, et al.: Should a Gleason score be assigned to a minute focus of carcinoma on prostate biopsy? Am J Surg Pathol 2000, 24:1634–1640.
Cina SJ, Epstein JI: Adenocarcinoma of the prostate with atrophic features. Am J Surg Pathol 1997, 21:289–295.
Tran TT, Sengupta E, Yang XJ: Prostatic foamy gland carcinoma with aggressive behavior: clinicopathologic, immunohistochemical, and ultrastructural analysis. Am J Surg Pathol 2001, 25:618–623.
Humphrey PA, Kaleem Z, Swanson PE, Vollmer RT: Pseudohyperplastic prostatic adenocarcinoma. Am J Surg Pathol 1998, 22:1239–1246.
Papandreou CN, Daliani DD, Thall PF, et al.: Results of a phase II study with doxorubicin, etoposide, and cisplatin in patients with fully characterized small-cell carcinoma of the prostate. J Clin Oncol 2002, 20:3072–3080.
Amin MB, Grignon DJ, Humphrey PA, Srigley JR: Gleason Grading of Prostate Cancer: A Contemporary Approach. Philadelphia: Lippincott Williams & Wilkins; 2004.
Ruijter ET, van de Kaa CA, Schalken JA, et al.: Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol 1996, 180:295–299.
Pan CC, Potter SR, Partin AW, Epstein JI: The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 2000, 24:563–569.
Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI: The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 2004, 28:394–398.
Gleason DF: Histologic grading of prostatic carcinoma. In Pathology of the Prostate. Edited by Bostwick DG. New York: Churchill Livingstone; 1990:91–92.
Greene FL, American Joint Committee on Cancer, American Cancer Society: AJCC Cancer Staging Manual. New York: Springer-Verlag; 2002:421.
Epstein JI, Netto GJ: Biopsy Interpretation of the Prostate, edn 4. Philadelphia: Lippincott Williams & Wilkins; 2007.
Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW: An updated catalog of prostate cancer predictive tools. Cancer 2008, 113:3075–3099.
Brimo F, Vollmer RT, Corcos J, et al.: Prognostic value of various morphometric measurements of tumour extent in prostate needle core tissue. Histopathology 2008, 53:177–183.
Bismar TA, Lewis JS Jr, Vollmer RT, Humphrey PA: Multiple measures of carcinoma extent versus perineural invasion in prostate needle biopsy tissue in prediction of pathologic stage in a screening population. Am J Surg Pathol 2003, 27:432–440.
Humphrey PA, Vollmer RT: Percentage carcinoma as a measure of prostatic tumor size in radical prostatectomy tissues. Mod Pathol 1997, 10:326–333.
Cheng L, Koch MO, Juliar BE, et al.: The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. J Clin Oncol 2005, 23:2911–2917.
Stamey TA, McNeal JE, Yemoto CM, et al.: Biological determinants of cancer progression in men with prostate cancer. JAMA 1999, 281:1395–1400.
de la Taille A, Rubin MA, Buttyan R, et al.: Is microvascular invasion on radical prostatectomy specimens a useful predictor of PSA recurrence for prostate cancer patients? Eur Urol 2000, 38:79–84.
Chuang AY, Nielsen ME, Hernandez DJ, et al.: The significance of positive surgical margin in areas of capsular incision in otherwise organ confined disease at radical prostatectomy. J Urol 2007, 178:1306–1310.
Cheng L, Bergstralh EJ, Cheville JC, et al.: Cancer volume of lymph node metastasis predicts progression in prostate cancer. Am J Surg Pathol 1998, 22:1491–1500.
Boormans JL, Wildhagen MF, Bangma CH, et al.: Histopathological characteristics of lymph node metastases predict cancer-specific survival in node-positive prostate cancer. BJU Int 2008, 102:1589–1593.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hameed, O. What is the pathologist saying? Interpretation of the prostate pathology report. Curr prostate rep 7, 141–147 (2009). https://doi.org/10.1007/s11918-009-0020-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11918-009-0020-z