Urothelial-type adenocarcinoma of the prostate mimicking metastatic colorectal adenocarcinoma

Adenocarcinoma arising in urinary bladder or prostatic urethra is uncommon. When they occur, the tumor can be mistaken for metastatic lesions, especially from the colon. Here we report the fifth case of a primary urothelial-type adenocarcinoma arising in the prostate which showed enteric differentiation. The patient was a 55 year-old male whose prostatic needle core biopsy showed a high grade adenocarcinoma which was initially thought to be metastatic colon cancer. A follow-up colonoscopy was unremarkable. Subsequent prostatectomy revealed a high grade adenocarcinoma which was positive for cytokeratins 7 and 20, carcinoembryonic antigen, CDX2, and high molecular weight cytokeratin, and negative for prostate specific antigen, prostate specific acid phosphatase and AMACR. A diagnosis of urothelial-type adenocarcinoma of the prostate was rendered. We review the literature regarding this entity, and discuss the differential diagnosis, emphasizing utility of immunohistochemistry in making the diagnosis. Finally, we speculate on the behavior of these rare tumors.     

PSA和肌氨酸在前列腺癌诊断中的价值

转移性前列腺癌组织中含量更高.本文综述PSA和肌氨酸在前列腺癌早期诊断中的价值.     

PSA和肌氨酸在前列腺癌诊断中的价值

转移性前列腺癌组织中含量更高.本文综述PSA和肌氨酸在前列腺癌早期诊断中的价值.     

PAP和PSA与前列腺癌诊治的关系

目的 :探讨前列腺酸性磷酸酶 (PAP)、前列腺特异抗原 (PSA)与前列腺癌的诊断、临床分期、预后判断的关系。方法 :用放射免疫测定法 (RIA)检测经病理检查证实的前列腺癌 5 2例 ,同时以 PAP、PSA辅助诊断。结果 :PSA阳性率明显高于直肠指检、B超和 PAP(P <0 .0 5 )。PAP和 PSA升高与前列腺癌的分期、肿瘤细胞分化程度具有相关性。结论 :PAP和 PSA对前列腺癌的诊断、临床分期、预后判断有较大应用价值     

PSA、 PSMA、 P504S在前列腺疾病中的表达及意义

目的 探讨前列腺特异性抗原(PSA)、前列腺特异性膜抗原(PSMA)、α-甲基酰基辅酶A消旋酶(P504S)在前列腺疾病组织中的表达差异及意义.方法 选取惠州市中心人民医院病理科201 1年7月～2013年7月前列腺穿刺标本157例,其中前列腺腺癌(PCa)38例,前列腺上皮内瘤变(PIN) 45例,非典型腺瘤样增生(AAH) 11例,前列腺良性增生(BPH) 63例,应用免疫组织化学技术检测前列腺组织中PSA、PSMA、P504S的表达.结果 PSA在各种前列腺组织中均有表达;PSMA在前列腺腺癌、前列腺上皮内瘤变、前列腺非典型腺瘤样增生、前列腺良性增生组织中的阳性表达率分别为65.8％、42.2％、18.2％、9.5％;P504S在以上组织中的阳性表达率则分别为94.7％、13.3％、9.1％、0％.结论 P504S在前列腺腺癌组织中高表达,其阳性表达率高于PSMA,可为前列腺腺癌的诊断提供参考依据.     

PSA相关标志物在前列腺癌诊断中的价值

目的 探讨在前列腺特异抗原(prostate specific antigen,PSA)灰区(PSA 4～10ng/mL)患者中,血清总PSA及游离PSA比值(f/tPSA)、前列腺特异性抗原密度(PSAD)和(f/t) PSA/PSAD值对穿刺病理结果的诊断价值.方法 回顾2008年1月至2016年3月本院接受经直肠超声(transrectal ultrasound,TRUS)引导下前列腺穿刺的患者929例,对其中249例PSA 4～ 10 ng/mL患者的临床资料进行了整理分析.根据病理结果,分为前列腺癌组(PCa组)38例(15.26％),前列腺增生组(BPH组)211例(84.74％).对患者年龄、tPSA、f/tPSA、体积、PSAD、(f/t) PSA/PSAD值进行统计学分析.结果 两组患者的年龄水平比较差异无统计学意义(P＞0.05);在f/tPSA、体积、(f/t) PSA/PSAD水平,BPH组大于PCa组;在tPSA、PSAD水平,PCa组大于BPH组,差异均有统计学意义(P＜0.05).PCa组患者中f/tPSA或PSAD异常者32例,占84.21％:BPH组中f/tPSA或PSAD异常者110例,占52.13％,差异有统计学意义(X2=13.52,P ＜0.005).结论 f/tPSA和PSAD异常对PSA灰区的患者是否行前列腺穿刺具有指导意义.如果f/tPSA和PSAD结果相矛盾,f/tPSA联合PSAD、PSAD联合(f/t) PSA/PSAD的诊断价值相对较高.     

PSA and hK2 in the diagnosis of prostate cancer

Serum markers for prostate carcinoma are widely applied for the purpose of early detection of cancer and the differentiation between benign and malignant disease, for the pre-treatment staging of detected prostatic cancers, and for the monitoring of prostate cancer after curative or palliative therapies. Since its discovery in 1979, serum PSA has been the most powerful marker of prostate cancer, but, when used alone, PSA is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Moreover, the molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, is a new complementary marker to PSA for early detection of prostate cancer. In this review, we examine PSA testing and its effectiveness in the diagnosis of prostate cancer. Further, we also evaluate recent literature regarding the use of hk2.     

Loss of heterozygosity at 12P12-13 in primary and metastatic prostate adenocarcinoma

PURPOSE: Our laboratory has recently identified a 1 to 2 Mb homozygous deletion at 12p12-13 in a prostate cancer specimen and determined that the p27/kip1 gene lies within the deletion. While immunohistochemical analysis has implicated p27/kip1 in prostate carcinoma, no previous studies had identified genetic abnormalities at this locus. Here, we examined primary and metastatic prostate tumors to determine if allelic loss occurs at this locus in localized disease and if it increases the risk of metastatic, high stage or high-grade disease. MATERIALS AND METHODS: DNA was extracted from prostate tumors and normal tissue of 99 patients. 60 tumors were primary, 20 were metastatic pelvic lymph nodes, and 19 were distant metastases. Multiple metastases were analyzed from 11 of 19 patients with metastatic disease. Polymorphic markers spanning our region of interest were PCR amplified from tumor and normal DNA. PCR products were then scored for allelic loss. RESULTS: Loss of heterozygosity (LOH) was identified in 14/60 (23%) primary tumors, 6/20 (30%) lymph node metastasis, and 9/19 (47%) distant metastases. The difference between primary and distant metastatic disease was statistically significant (p = 0.045, Fisher's exact test). The pattern of LOH was identical in all metastatic sites obtained from individual patients, indicating that genetic loss occurred prior to metastasis. Subset analysis of the 60 primary tumors demonstrated no association between LOH and adverse pathological feature [nodal involvement, seminal vesicle invasion, margin positivity, high Gleason score (7-10)]. CONCLUSIONS: Demonstrating that 12p12-13 LOH is a prominent feature of primary prostate tumors and that multiple metastatic foci have an identical LOH pattern, provides evidence that gene inactivation in this region occurs prior to metastasis. In addition, the strong association between LOH and distant metastasis raises the possibility that mutational inactivation of a gene at 12p12-13, possibly p27/kip1, plays a pivotal role in the development of metastatic disease.     

血清T-PSA、F/T在前列腺疾病诊断中的意义

目的：探讨总前列腺特异抗原（T－PSA）、游离PSA（F－PSA）与T－PSA比值（F／T）在良性前列腺增生（BPH）、慢性前列腺炎及前列腺癌（PCa）诊断中的作用。方法：检测80例BPH、26例慢性前列腺炎、30例PCa患者的T－PSA、F－PSA，并计算出相应的F／T值。结果：三组患者之间的T－PSA差异存在非常显著性意义（P＜O．01）；BPH患者的F／T与PCa患者差异存在显著性意义，与慢性前列腺炎患者差异无显著性意义；当T－PSA在4．0－10μg/L时，三组患者的T－PSA差异无显著性意义，而BPH患者的F／T与PCa患者差异存在显著性意义，与慢性前列腺炎患者差异无显著性意义；在10μg/L＜T－PSA＜30μg/L时，前列腺炎与PCa患者之间的F／T差异有非常显著性意义（P＜0．01）。结论：F／T可以提高T－PSA对PCa、慢性前列腺炎、BPH的鉴别诊断的特异性。     

P504S、CK34βE12、p63、PSA在前列腺腺癌病理诊断中的应用

目的探讨P504S（α-甲酰基-辅酶A消旋酶）、高分子细胞角蛋白（CK34βE12）、p63、前列腺特异性抗原（PSA）在前列腺腺癌病理诊断中的应用价值。方法对46例前列腺腺癌、8例前列腺高级别上皮内瘤（HGPIN）和35例良性前列腺增生（BPH）标本进行P504S、CK34βE12、PSA、p63和免疫组织化学染色。结果46例前列腺腺癌标本中，P504S阳性表达42例（91＋3％），其中弥漫性胞质阳性（＋＋＋）25例（54＋3％），HGPIN标本阳性7例（87．5％），1例（2．9％）BPH标本有少量腺体微弱表达；HGPIN标本中CK34βE12及p63连续或断续表达8例（100．0％），BPH标本阳性表达33例（94．3％），46例前列腺腺癌标本均未见表达；前列腺腺癌标本中PSA阳性表达44例（95．7％）。结论P504S诊断前列腺腺癌敏感性高，特异性较好，结合HE切片、CK34βE12、p63和PSA等免疫组织化学染色检测可提高前列腺腺癌病理诊断的准确性。     

血清／尿PSA比值对血清PSA处于“灰区”中前列腺癌的诊断价值

目的探讨血清前列腺特异性抗原（sPSA）与尿前列腺特异性抗原（uPSA）比值（s／uPSA）对血清PSA处于诊断“灰区”—sPSA于4．0～10．0ng／ml（放射免疫法范围）前列腺癌的诊断价值。方法选择血清PSA（sPSA）于诊断“灰区”的共191例前列腺疾病患者，采用放射免疫方法检测其尿PSA（uPSA）水平，根据前列腺活检结果分为前列腺癌组（PCa组，n=76）和良性前列腺增生症组（BPH组，n=115），比较两组s／uPSA比值以及两组间sPSA和s／uPSA比值的受试者运算特性曲线（ROC）面积。结果BPH组与PCa组的sPSA分别为（5．20±1．09）ng／ml和（6．41±2．12）ng／ml，uPSA分别（3．57±0．97）ng／ml和（2．17±0．61）ng／ml，sPSA和uPSA在BPH组与PCa组两者间差别均无统计学意义（t=0．91，t=1．24，P〉0．05）;BPH组与PCa组的s／uPSA分别为（2．32±0．61）和（4．13±1．09），PCa组s／uPSA比值明显高于BPH组，差别具有统计学意义（t=4．17，P〈O．01）。s／uPSA比值和sPSA的ROC曲线下面积分别为0．836和0．703。在保持95％敏感性时，s／uPSA比值和sPSA的特异性分别为77．1％和39．6％。结论在血清PSA值4．0～10．0ng／ml范围内，s／uPSA比值较sPSA更好地检出前列腺癌：在保持同一敏感性时，s／uPSA较sPSA具有更高的特异性。     

前列腺腺癌患者血清PSA水平对Gleason评分的预测价值

目的探讨前列腺腺癌患者血清前列腺特异性抗原(PSA)水平对Gleason评分的预测价值。方法研究血清PSA三种主要指标和Gleason分级主要指标均值;比较不同组别之间的差异,分析血清PSA与Gleason评分相关性,并观察血清总PSA(tPSA)与Gleason评分之间变化趋势。结果血清tPSA≤4.0、4.1~10.0、10.1~20.0、20.1~100.0、100.0ng/mL组Gleason评分均值分别为6.31±0.47、6.66±0.89、7.04±1.11、7.56±1.03以及7.91±1.01;血清游离PSA(fPSA)≤1.0、1.1~10.0、10.0组Gleason评分均值分别为6.45±0.69、6.98±0.98以及7.75±1.05;血清总PSA(tPSA)t/fPSA≤0.16、0.17~0.50以及0.50组Gleason评分均值分别为6.72±0.88、7.45±1.04以及8.36±1.12。血清tPSA、fPSA以及fPSA/tPSA比值分别与Gleason评分、主要分级以及次要分级显著正相关;Gleason评分、主要分级以及次要分级均随血清tPSA、fPSA以及fPSA/tPSA逐渐增加而增加。结论前列腺腺癌患者血清PSA对Gleason评分的具有预测价值;与fPSA和fPSA/tPSA比值相比,tPSA是最有预测价值的指标。     

Rare case of metastatic prostate adenocarcinoma to the pituitary

We report a rare case of metastatic prostate adenocarcinoma to the pituitary gland. The patient had lung and bone metastases when he presented with bitemporal hemianopsia. He was also receiving total androgen blockade at that time. Magnetic resonance imaging showed an intrasellar mass, and biopsy confirmed metastatic prostate cancer. Radiotherapy, in the form of intensity-modulated radiotherapy, was delivered to the intrasellar mass. The patient responded well to radiotherapy. The mechanisms of spread to the pituitary gland and treatment options, including intensity-modulated radiotherapy, are discussed.     

Measurement of complexed PSA in the differential diagnosis between prostate cancer and benign prostate hyperplasia

BACKGROUND: To enhance the specificity of PSA in diagnosis of cancer, several approaches have been evaluated, having in common the study of fractions of PSA. The aim of this study was to evaluate the usefulness of complexed PSA in the differential diagnosis between benign prostate hyperplasia (BPH) and prostate cancer. METHODS: We determined the concentrations of complexed PSA (Bayer, Tarrytown, NY) and total PSA (Tandem-R Assay, Hybritech Incorporated, San Diego, CA) in 196 patients with BPH and in 55 patients with prostate cancer. Likewise, the percentage of free PSA (Wallac, Turku, Finland) was determined for 124 of these patients. RESULTS: The specificity of complexed PSA was found to be greater than that of total PSA for the cutoff values corresponding to sensitivities of 80%, 85%, and 90%. Similarly, the area under the curve obtained by receiver-operating curve analysis was greater for complexed PSA than for total PSA, although significant differences were not observed. The diagnostic usefulness of complexed PSA in the differential diagnosis between BPH and prostate cancer was found to be lower than the percentage of free PSA. CONCLUSIONS: We believe that differential diagnosis with complexed PSA between BPH and prostate cancer is of little use, due to low efficacy when PSA results are extreme.     

PSAD与双参数前列腺磁共振联合应用在前列腺癌诊断中的意义

目的 评估前列腺特异性抗原密度(PSAD)、双参数前列腺磁共振单一检测及二者联合在前列腺癌患者中的诊断价值。方法 对169例前列腺穿刺的患者进行了回顾性研究（所有患者均于穿刺前行前列腺MRI检查）。通过记录每位患者的PSAD和双参数前列腺磁共振（由T2WI序列及DWI序列组成）结果,进而通过回归曲线和逻辑回归分析,评价PSAD和双参数前列腺磁共振（bp-MR）在前列腺癌早期诊断中的临床应用价值。结果 PI-RADS评分在ROC曲线下的面积为（0．890±0．027）,PSAD在ROC曲线下的面积为（0．843±0．031）, bp-MR与PSAD联合检测在ROC曲线下的面积为（0．932±0．020）。PSAD、PI-RADS评分及二者联合的敏感度分别为67．4%、84．3%、84．3%,特异度分别为90．0%、91．2%、87．5%。结论 bp-MR对于前列腺癌的预测效果要显著强于PSAD,,并且PSAD与bp-MR两种检测方法相结合能够显著提高临床上早期前列腺癌的诊断效能。