Serum prostate-specific antigen and prostate pathology in men having simple prostatectomy.

Prostate-specific antigen (PSA) is a sensitive and specific serum marker for monitoring disease activity in men with prostatic carcinoma. Despite reports of elevation of levels of this analyte in men with benign prostatic hyperplasia, no information is available correlating the serum levels with the actual prostatic abnormalities in men having prostatectomy for presumed benign disease. In the present investigation, the authors compared preoperative serum PSA levels with prostate disease in 81 men with bladder outlet obstruction. Five pathologic groups were found: incidental high-grade carcinoma (n = 3), low-grade carcinoma (n = 11), acute inflammation (n = 16) with or without chronic inflammation, Prostatic intraepithelial neoplasia (PIN) (n = 25), and benign hyperplasia (n = 26). Serum PSA levels were significantly elevated in both low- and high-grade carcinoma, acute inflammation, and PIN when compared with the patients with benign hyperplasia with and without chronic inflammation. Within the four groups with elevated levels, use of PSA levels could separate only the high-grade cancer patients who were subsequently shown to have metastatic disease. Only one patient with simple hyperplasia had PSA levels in the abnormal range.

Prostatic intraepithelial neoplasia: a lesion that may be confused with cancer on prostatic ultrasound.

Most prostatic adenocarcinomas reveal a hypoechoic peripheral zone lesion on transrectal ultrasonography. Numerous benign processes can have similar transrectal ultrasound findings. We report 8 cases of transrectal ultrasound-guided prostatic biopsies of peripheral zone hypoechoic lesions that demonstrated prostatic intraepithelial neoplasia, a presumed premalignant lesion. Immunohistochemistry using an antibody directed against cytokeratins 5 and 14 was performed to exclude carcinoma. Of the men 2 had invasive carcinoma on repeat biopsy and 1 had carcinoma diagnosed on subsequent transurethral resection. Patients with prostatic intraepithelial neoplasia on biopsy of hypoechoic peripheral zone lesions merit careful monitoring.

The relationship of basement membrane to histologic grade of human prostatic carcinoma.

The presence or absence of basement membrane (BM) was examined in normal and neoplastic adult prostatic tissue as well as prostate cell lines using immunohistochemistry and electron microscopy. Immunohistochemical studies using antibodies directed against laminin and type IV collagen were done on 55 samples of human prostate representing various grades of prostate carcinoma. The percentage of glandular structures surrounded by BM was determined. Benign prostates (n = 15) had BM around 99% of the acini. Gleason Grade II adenocarcinoma (n = 9) had 65%, Grade III (n = 5) had 23%, Grade IV (n = 12) had 15%, and Grade V (n = 7) had 0% BM around glandular structures, respectively. None of the metastases (n = 7) had visible BM. By transmission electron microscopy, 32 prostates were examined for the glandular profile of BM. One hundred percent of the acini in the benign prostates (n = 17) had BM. Of the low grade carcinomas, Gleason I and II (n = 4), 44% of the acini had BM, and of the high grade carcinomas, Gleason IV and V (n = 7), 34% had BM. None of the metastases (n = 4) had BM by electron microscopy. We conclude that, in prostatic carcinoma, there is a progressive loss of BM with decreasing differentiation, and that in prostate carcinoma metastases there is a complete loss of epithelial BM.

Cranial metastases from prostate cancer simulating meningioma: report of two cases and review of the literature.

Two cases of prostatic carcinoma metastatic to the cranium that presented with clinical and radiographic features simulating meningioma are described. The literature was reviewed, and 13 similar cases were identified. From the data gathered, we conclude that metastatic prostate cancer should be considered in the differential diagnosis of elderly males who present with characteristic clinical and radiological features of meningioma and that the classical description of meningioma is not specific.