Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Minute Cancer in Prostate Core Biopsies
      
The finding of atypical small acinar profiles lesions (ASAP), with or without presence of luminal pink granular secretions, mucin, or crystalloids, means that cancer is 42% likely to be found ion rebiopsy
1
. In early 2010, Dr. Morrow began using the PCA3 test to help decide in several types of PSA elevation situations when to rebiopsy. The finding of the most minute focus of cancer in even only one of 14 biopsy cores does not guarantee that the cancer in the gland is small. Therefore, execution of an excellent systematic method of processing such cores; and committed, trained, and sharp-eyed interpretation of the core histopathology is essential. Not only will this attention to detail help prevent a false-negative diagnosis, it will help prevent an understaged mindset as treatment options are considered & then executed. And it will allow utilization of such as the Hamburg algorithm in pre-treatment decision making. The first 18 cases below represent a portion of the "minute carcinoma" cases in our practice  from the first quarter of  2001.The others since are simply a few additional examples for your interest.

References:

  1. Iczkowski KA, Bassler TJ, Schwob VS, Bassler IC, Kunnel BS, Orozco RE, Bostwick DG., "Diagnosis of "suspicious for malignancy" in prostate biopsies: predictive value for cancer",Urology, 51(5):749-57; discussion 757-8. SourceDepartment of Pathology, Mayo Clinic, Rochester, Minnesota, USA. May 1998.

Case Number Patient Age PSA level Number of Core Biopsies Minute Cancers
Found		 Present on How Many of The 6+ Slides? Staging Impact
S-01-112 51 5.3 sextant 2  RA 2 of 6
LA 2 of 6		 neg. to T2c
S-01-262 58 4.3 octant 1  LA 6 of 6 neg. to T1c
S-01-405 65 6.5 pattern
3 right		 1
(also a regular RB pos.)		 RM 2 of 6  T1c to larger T1c
S-01-877 85 10.2 octant 1 RB RB 3 of 6 neg. to T1c
S-01-887 65 6.5 sextant 1 LB
1 RB		 LB 3 of 6
RB 6 of 6		 neg. to T2c
S-01-26 63 34.8 sextant 1RB
1RM
( 2 reg. left pos.) 		RB 6 of 6
RM 6 of 6		 T1c to T2c
S-01-262 58 4.3 octant 1 LA 6 of 6 neg. to T1c
S-01-863 71 5.5 octant 1 LA/M
5 of 9		 neg. to T1c
S-01-1004 66 7.5 octant 1 LA 6 of 6 neg. to T1c
S-01-1175 71 27.4 10
pattern		 1 RA 3 of 6 neg. to T1c
S-01-1204 51 5.4 sextant
plus 1		 1 RB
1 LB
(3 reg. right pos.)		 RB 2 of 6
LB 6 of 6		 T1c to T2c
S-01-1272 77 4.2 sextant 1 RB 6 of 6 PIN III/CIS
S-01-529 75 6.7 sextant 1
(1 reg. right pos.)		 RB 1 of 6 small to larger T1C
S-01-594

 

70

 

 6.3 sextant 1
(1 reg. right pos.)		 LM 6 of 6 T1c to T2c
S-01-805 67 2.2 sextant 1

LB 6 of 6

 neg. to T1c
S-01-2517 76 5.5 sextant 1
(reg.  right pos.)		 LB 6 of 6 T1c to T2c
S-01-2841 69 4.2 sextant 1
(reg.  RA and LB pos.)		 LB 6 of 6 T2c to larger T2c
S-01-3205 71 10.6 octant 3 LB 3 of 6
LM 2 of 8
LA 6 of 6		 neg. to larger T1C
S-01-5560 61 14.3 sextant 1
(reg. RB pos.)		 LB 6 of 6 T1c to T2c
S-01-5375 55 5.5 octant 1  RL 6 of 6 neg. to T1c
S-01-8629 64 1.3 sextant 1 LB 6 of 6 neg. to T1c
S-01-11814 62 4.6 sextant 2
(reg. LM pos.)
[2 other cores had eosinophilic intraluminal crystalloids in benign acini]		 RM 4 of 6
LA 6 of 6		 T1c to T2c
S-01-13314 66 4.5 12.6%free sextant 1 RA 6 of 6 neg to T1c
S-01-14067 58 6.5 sextant 1 RM 3 of 6 neg to T1c
S-01-14595 67 6.7 sextant 1 LM 2 of 6 neg to T1c
S-02-73 57 5 octant 1 L? 6 of 6 neg to T1c
S-02-108 81 9.7 sextant 1 RM 3 of 6 neg to T1c
S-02-1238 44 8.4 10-tant 2 2 left neg to T1c
S-02-1349 66 5.9 octant 3 2 left & 1 right neg to T1c
S-02-1557 70 4.7 octant 2 1 right & 1 left neg to T1c
S-02-1742 59 8.5 octant 2 2 left neg to T1c
S-02-1743 53 4.4 octant 1 1 left neg to T1c
S-02-1903 51 4.0 bilateral 1 1 right neg to T1c
S-02-2518 65 6.3  3-tant 1 LM 5 OF 6 neg to T1c
S-02-2526 58 16.4 sextant 1 LA 6 of 6 neg to T1c
S-02-3172 70 7.0 octant 1 L? 2 of 6 neg to T1c
S-02-3741 74 11.5 10-tant 2 RB 3 of 6
RTZ 3 of 6		 neg to T1c
S-02-3989 56 4.8 octant 1 LM 6 of 6 neg to T1c
S-02-4757 70 10.1 octant 3 L 6 OF 6
R 4 OF 6
R 2 OF 6		 T1c to T2c
S-02-4759 74 5.2 octant 2 R 3 of 6
L 5 of 6		 neg to T2c
L-02-2608 64 ? sextant 1  LA 6 of 7 neg to T1c
S-02-5109 73 8 octant 1 RM 4 OF 6 neg to T1c
S-02-5248 64 4.8 10-tant 1 L 2 of 6 neg to T1c
S-02-5752 51 4.0 right 3-tant 1 RB 6 of 6 neg to T1c
S-02-6598 56 7.7 octant 1 R 4 of 6 neg to T1c
S-02-6677 65 6.9 sextant 2 LM 35of 9
LA 2 of 6		 neg to T1c
S-02-6678 54 4.7 octant 2 RTZ 3 of 6
LA 4 of 6		 neg to T2c
S-02-6934 53 1.5 octant 1 R 5 of 6 neg to T1c
S-02-6944 53 10.4 octant 4 RTZ 2 of 6
LA 1 of 6
LM 4 of 6
LB 6 of 6  		 neg to T2c
S-02-6945 69 8.2 octant 1 LTZ 4 of 6 neg to T1c
S-02-7090 66 7.1 7-tant 3 R 6 of 6
R 4 of 6
L 6 of 6 		 neg to T2c
S-02-7114 61 4.2 octant 1 R 5 of 6 neg to T1c
S-02-7164 67 5.9 2-tant 1 R 5 of 6 neg to T1c
S-02-7214 77 17.9 10-tant 1 LTZ 6 of 6 neg to T1c
S-03-482 72 6.7 20-tant 1 R  neg to T1c
S-03-501 57 5.0 octant 1 LB neg to T1c
S-03-1677 58 5.6 sextant 1 LB 2 of 6 neg to T1c
LMC-03-1949 43 3.8 sextant 1 RB 8 of 8 neg to T1c
S-03-3451 60 5 one 1 R 3 of 7 neg to T1c
S-03-4334 66 1.4 4-tant 1 RM 2 of 6 neg to T1c
S-04-7502** 76 11.5 9-tant 2 LL 1 of 9 neg to T1c
S-04-12977 73 10.1 10-tant 3 RA 6 of 6
RM 1 o 6
LA 5 of 6

neg to T2c
S-04-14496 62 11.4 14-tant 1 RM neg to T2c; many foci everywhere in the radical
S-05-2761 64 5.61 10-tant 2 LA 2 of 6
LM 2 of 6		neg to T1c
 
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