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| Prostate
histological response to treatment |
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Pathologists may be presented with
post-treatment (radiation and/or androgen deprivation) biopsies
because PSA monitoring has begun to show a rise. Or, we may be
asked to evaluate a radical postatectomy specimen after either
or both of the treatments. We have seen one case in which the
cancer could not be found (though the palpable nodule could be
seen) post-androgen-deprivation (CHD). So, it is obviously important
to know the patient's history when searching for cancer! Radiation
atypia lasts 10 years or more, especially with seeds; best not
to biopsy in shorter than 12 months post-treatment; PSA rise
treatment failure probably needs treatment even if biopsies negative
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KEY RULE #1: The Gleason scoring and
grading can appear to be significantly worse post-treatment.
By convention, this is considered artifactual and does not change
the Gleason status of a case. The Gleason status of a case is
that determined prior to any treatment (if a case is
having subsequent histological sampling following either or both
of CHD and radiation).1
KEY RULE #2: The 1st three most important
histological observations in post-treatment assessment are pattern,
pattern, and pattern.1
PEARL #1: Immunohistochemical stains
can be a huge help (LMW-keratin and K903...but not PSA)! LMW-keratin
stains all (benign or malignant) prostate epithelium, and K903
stains basal cells whose presence marks benign glands.1
PEARL #2: The therapy induced changes
can vary dramatically within the same gland...fields with severe
effect and fields with hardly any change1.
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status/post androgen-deprivation
changes:
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on the normal/benign gland
components:
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normal ductulo-lobular
PATTERN is maintained
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causes secretory atrophy
(low columnar to cuboidal change0
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causes secretory cell
cytoplasmic vacuolation
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may cause lymphohistiocytic
infiltration in areas of affected glands
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may cause transitional
or squamous metaplasia
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on the malignant gland components:
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negative for normal ductulo-lobular
PATTERN
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decreases gland/acinar
size
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decreases cell, nuclear,
and nucleolar size
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causes cytoplasmic vacuolation...even
cell lysis
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lymphohistiocytic foci
may "mark" areas of damaged and H&E
vague cells or foci of total lysis (LMW-keratin may
light up remnant cells)
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status/post radiation changes:
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on the normal/benign gland
components:
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normal ductulo-lobular
PATTERN is maintained
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causes gland atrophy
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causes epithelial atypicality
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K903 positive1 [S-01-5754];
even if pattern looks focally abnormal [LMC-01-4877; S07-8606]
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on the malignant gland components:
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negative for normal ductulo-lobular
PATTERN
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causes cancer acinar atrophy
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causes cancer-cell mild
to marked atypicality
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K903 negative1
References:
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William C. Allsbrook, Jr., MD,
of Medical College of Georgia, seminar of 21 April 2001.
(and AJSP Oct. 1999 p. 1021)
(posted May 2001;
latest addition 19 July 2004) |
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© Copyright
1999 - 2006, all rights reserved, Pathology Associates Of Lexington,
P.A. |
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