Precancerous lesions of the prostate: Pathology and clinical implications
- Ximing J Yang, MD, PhD
Ximing J Yang, MD, PhD
- Northwestern University Feinberg School of Medicine
- Chief of Urologic Pathology
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
The study of precancerous lesions of the prostate is important for understanding prostatic carcinogenesis and for developing potential chemopreventive measures for prostate cancer.
Four major pathologic entities will be discussed in this topic review: prostatic intraepithelial neoplasia (PIN), atypical adenomatous hyperplasia (AAH, also termed adenosis), atrophic lesions, and atypical small acinar proliferation (ASAP). High-grade PIN is the most likely precursor of the majority of prostatic adenocarcinomas. In contrast, AAH and atrophic lesions are possible, although uncertain, precancerous lesions. ASAP is not a true biological entity but is a diagnostic term in pathology when a lesion suspicious for but not diagnostic of carcinoma is identified. The pathologic characteristics, prevalence, relationship to prostate cancer, and clinical significance of these lesions are discussed in this topic, with a particular emphasis on PIN.
PROSTATIC INTRAEPITHELIAL NEOPLASIA
Prostatic intraepithelial neoplasia (PIN), first described in 1969 , is a neoplastic proliferation of prostatic epithelial cells that is confined to preexisting prostatic ducts or acini (glands). PIN was further characterized and initially termed intraductal dysplasia in 1986 ; the currently used term "prostatic intraepithelial neoplasia" was introduced in 1987 and endorsed by consensus at a 1989 conference [3,4].
Histology — The histologic characteristics of PIN have been well described [5,6]. The neoplastic prostatic epithelial cells are within prostatic ducts or acini, which are typically large and branched, with a convoluted inner contour similar to benign glands (picture 1). Epithelial cell proliferation produces a layer of crowded, pseudostratified, neoplastic cells with cytologic atypia, characterized by nuclear irregularity, nucleomegaly, hyperchromasia, and prominent nucleoli (picture 1). These findings are similar to those of invasive prostate cancer. (See "Interpretation of prostate biopsy".)
In contrast to adenocarcinoma, the architecture is normal, and the PIN glands characteristically contain basal cells around their periphery, seen as a thin and occasionally discontinuous layer on hematoxylin and eosin (H&E) stained sections. Immunohistochemical staining for high molecular weight cytokeratins (34bE12 antibody) easily demonstrates the basal cells (picture 2). This is an important diagnostic feature because the presence of basal cells can help to differentiate PIN from prostatic adenocarcinoma, in which basal cells are absent [3,7-10]. (See "Interpretation of prostate biopsy".)
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- PROSTATIC INTRAEPITHELIAL NEOPLASIA
- - Diagnosis
- Relationship to cancer
- Clinical significance
- - High-grade PIN
- - Low-grade PIN
- Management of high-grade PIN
- - Rebiopsy
- - Atypical small acinar proliferation
- - Specific treatment
- ATYPICAL ADENOMATOUS HYPERPLASIA (ADENOSIS)
- INTRADUCTAL CARCINOMA OF THE PROSTATE
- ATROPHY AND ATROPHIC LESIONS