Risk factors and misdiagnosis of intraductal carcinoma of prostate (IDC-P)in patients with metastatic prostate cancer / 中华泌尿外科杂志

Objective:To investigate the risk factors and missed diagnosis of intraductal carcinoma of prostate (IDC-P) in patients with metastatic prostate cancer.Methods:The preoperative PSA, prostate MRI, bone scans and lung CT of all patients who underwent prostate biopsy in Department of Urology, Xiangya Hospital, Central South University from January 2018 to July 2020 were reviewed. A total of 261 patients with high suspicion of metastatic prostate cancer were screened for inclusion. Two full-time senior pathologists of urogenital tumors in Xiangya Hospital independently reviewed their pathological sections and detected IDC-P according to the 2016 WHO tumor classification. Diagnostic criteria are defined as malignant epithelial cells filling large acini and prostatic ducts, with preservation of basal cells and solid or dense cribriform pattern/loose cribriform or micropapillary pattern with either marked nuclear atypia or non-focal comedonecrosis.Results:The detection rate of IDC-P was 29.12%(76/261), while the actual reporting rate was only 9.96%(26/261). The results of subgroup analysis including age, PSA level, Gleason score as well as different metastatic sites showed that detection rate of IDC-P was 33.69% in the PSA≥50 ng/ml subgroup, much higher than 17.57% in the PSA <50 ng/ml subgroup ( P=0.0039); And it was 32.33% in the Gleason score ≥ 8 subgroup, much higher than 3.45% in the Gleason score < 8 subgroup ( P<0.01). It was not significantly different in different age subgroups as well as different metastatic site subgroups. These data suggest that PSA ≥ 50 ng/ml as well as Gleason score ≥ 8 may be risk factors of IDC-P.157 samples were stained by immunohistochemistry. The detection rates of IDC-P were 84.21% (16/19) in P63 (+ ) samples, 36.00% (9/25) in ERG (+ ) samples. There were 3 samples with both P63 (+ ) and ERG (+ ), all of which had IDC-P. Conclusions:There is misdiagnosis of IDC-P on prostate needle biopsy in patients with metastatic prostate cancer currently. PSA ≥ 50 ng/ml and Gleason score ≥ 8 are risk factors of IDC-P. Thus, attention should be paid to the possibility of IDC-P in such patients. When the diagnosis is difficult, immunohistochemical staining for ERG and P63 is helpful in IDC-P determination.

Intraductal Carcinoma of the Prostate Gland: Recent Advances

Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up.

Clinical Evaluation of FPSA/PSA Ratio in the Differential Diagnosis of Prostate Carcinoma and Benign Prostate Hyperplasia / 中国医师杂志

Objective To explore the clinical significance of FPSA/PSA ratio in the differential diagnosis of prostate carcinoma(Pca) and benign prostate hyperplasia (BPH). Methods The concentrations of FPSA and PSA in 52 patients with Pca or BPH were analysed retrospectively to calculate FPSA/PSA ratio. Results FPSA/PSA ratio between the Pca and BPH was markedly different (t=4 01,P