Page 515 - Concise Pathology for Exam Preparation ( PDFDrive )

500 SECTION II Diseases of Organ Systems

• Local invasion into seminal vesicles, adjacent soft tissue and wall of the urinary bladder
may be seen.
• Invasion of rectum is less common (Denonvilliers, fascia separating the lower urinary
tract structures from the rectum, prevents growth into the rectum).

Microscopy
Four histological types:
1. Adenocarcinoma
2. Transitional cell carcinoma
3. Squamous cell carcinoma
4. Undifferentiated carcinoma
Adenocarcinoma Prostate
• It is the most common histological type (96% cases).
• The tumour is composed of closely packed acini arranged in a back-to-back manner
with little or no stroma between them.
• Glands may be well differentiated to almost undifferentiated and are lined by a single
layer of epithelium (basal layer seen in normal or hyperplastic glands is absent). Tumour
cells may be clear, hyperchromatic or eosinophilic (granular).
• Foci of intraepithelial neoplasia (PIN) may be seen in close association with carcinoma.
• Invasion of intraprostatic perineural spaces is a common occurrence.

Grading of Carcinoma Prostate

Gleason grading is the most widely used grading system for adenocarcinoma prostate. It is
based on the glandular architectural patterns and the relationship of the tumour cells with
the stroma.
Diagnosis and Staging of Carcinoma Prostate

• Digital rectal examination: Most of the prostatic tumours are located in posterior lobe,
so are easily palpable on per rectal examination.
• Transrectal ultrasonography with guided biopsy for early detection of tumour.
• Computed tomography and magnetic resonance imaging scan to evaluate the lymph
node status.
• Pelvic lymphadenectomy to look for microscopic metastasis as metastasis to regional
pelvic lymph nodes can occur.
• Skeletal survey or radionuclide scanning for detection of osteoblastic metastasis.
• Tumour marker assays:
• Prostatic acid phosphatase (PAP):
• Secreted by normal as well as cancerous prostatic epithelial cells.
• Serum level is highly raised in prostatic cancer extending beyond the capsule or in
metastases.
• Normal values: 1–3 KA° units, more than 5 KA° unit is diagnostic of the cancer.
• Prostate-specific antigen (PSA):
• Produced by the prostatic epithelium and secreted in small quantities in the serum,
PSA cleaves and liquefies seminal coagulum by its enzymatic activity (androgen-
regulated serine protease).
• Any condition that disrupts the normal architecture of prostate, whether adenocar-
cinoma, NHP or prostatitis, can elevate serum levels of PSA.
• A serum PSA of more than 4 ng/mL is most useful in diagnosing prostatic
cancer; particularly, in combination with rectal examination and transrectal
ultrasonography.
• PSA levels are generally higher in cancer as compared to nodular hyperplasia, but
their values may overlap, so criteria other than simply serum levels to be looked
for; namely, free PSA levels (levels lower than 10% is indicative of prostatic cancer

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