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The Pathology of Prostatic Carcinoma

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Prostate Cancer: A Comprehensive Perspective

Abstract

Adenocarcinoma of the prostate (also referred to a prostatic carcinoma) comprises 95 % of prostatic neoplasms. The pathologic diagnosis of prostatic carcinoma is based on a combination of features. The diagnostic features are grouped into primary criteria (architectural) and secondary criteria (cytologic). Tertiary criteria (cytoplasmic and luminal) are supportive of the diagnosis. In diagnostically challenging cases, immunohistochemical stains are used to confirm the diagnosis. Mimickers of prostatic carcinoma are described, including clear cell cribriform hyperplasia, atrophy, basal cell hyperplasia, atypical adenomatous hyperplasia, and seminal vesicle epithelium.

The universally used grading system for prostatic carcinoma is the Gleason grading system, in which the primary and secondary patterns are combined into the Gleason score. In this chapter, the Gleason grading system, including the patterns and scores, is discussed, as are issues of reproducibility and the predictability of prostatectomy Gleason score from the biopsy.

Specific issues related to diagnosing needle biopsy and TURP specimens are discussed. Clinically significant aspects about the grossing, pathologic diagnosis and staging of radical prostatectomy specimens are highlighted. Other issues mentioned are the changes in benign and malignant prostatic glands following radiation and hormonal therapy. Another vexing issue discussed is the absence of prostatic carcinoma in prostatectomy specimens after a diagnosis of carcinoma on needle biopsy.

While the vast majority of prostate cancers are acinar adenocarcinomas with a relatively similar histologic appearance, some acinar adenocarcinomas have a distinct morphologic appearance that may make diagnosis difficult. Recognition of these variants, as well as other types of carcinoma that can be found in the prostate, is important for clinical and prognostic purposes. The histologic and clinicopathologic features of these types of prostate cancers are addressed.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, F-309C, New York, NY, 10065, USA

    Maria M. Shevchuk M.D., FCAP

  2. Department of Pathology and Laboratory Medicine and Department of Urology, Weill Cornell Medical College, 525 East 68th Street, Starr-1009, New York, NY, 10065, USA

    Brian D. Robinson M.D.

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  1. Maria M. Shevchuk M.D., FCAP
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  2. Brian D. Robinson M.D.
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Correspondence to Maria M. Shevchuk M.D., FCAP .

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Editors and Affiliations

  1. New York Presbyterian Hospital, Brady Urologic Health Center, Weill Cornell Medical Center, East 68th Street 525, New York, 10021, New York, USA

    Ashutosh Tewari

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Shevchuk, M.M., Robinson, B.D. (2013). The Pathology of Prostatic Carcinoma. In: Tewari, A. (eds) Prostate Cancer: A Comprehensive Perspective. Springer, London. https://doi.org/10.1007/978-1-4471-2864-9_20

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  • DOI: https://doi.org/10.1007/978-1-4471-2864-9_20

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